Saturday, January 5, 2013, San Diego, California

Title Dr. Mr. Mrs. Ms. Professor First Name Last Name

Street Address

Town/City Province/State Zip/Postal Code

Country

Telephone

E-mail

Name of Organization

$125 per dinner

$95 per dinner for EPS members (before December 21)

$25 per dinner for students

EPS memberships are $35.  Become a member of EPS before December 21 to receive the member discount on the dinner.

You can also honor Michael Intriligator by supporting the dinner:

Benefactor $5000

Patron $1000

Sponsor $500

After you click submit you will be taken to a page where you can enter your credit card information. It is not necessary to re-enter all of your contact information again. Thank you for registering for this event. We look forward to seeing you in San Diego in January.

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