Please return your check with the form below by Friday, September 11, 2009.

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Please RSVP with Payment to:                    Name(s) of Attendees                               Student?           

California Los Padres ACS      ________________________         _____
Dept. of Chemistry and Biochemistry
University of California                          ______________________________            ______
Santa Barbara, CA 93106-9510
                                                                ______________________________            ______

                                                                ______________________________            ______                                                    

 ($20 per person, $10 per student)

Please provide contact email or phone # _________________________     Amount Enclosed: ________