Please return your check with the form below by Monday, September 28, 2009.

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Please RSVP with Payment to:                    Name(s) of Attendees                               Student or 50+ yr member?           

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

                                                                ______________________________             ______                                                    

 ($25 per person, $15 per student/50+ yr member)

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