Name_____________________________________________________________________

Position_________________________________________________________________

Department_______________________________________________________________

Institution______________________________________________________________

Street Address___________________________________________________________

City, State, Zip_________________________________________________________

Telephone______________________________ Fax______________________________

Email____________________________________________________________________

Sex: Male___ Female___

Degree(s): MD___ PhD___ DVM___ MBBS___ BS____ Assoc. Degree____
Other:__________________________________________________________________

Submit this application form to:

        Great Lakes International Imaging and Flow Cytometry Association
        Laboratory of Flow Cytometry
	Roswell Park Cancer Institute
	Elm & Carleton Streets
	Buffalo, New York,  14263

MAILING ADDRESS (If different from above)

Street___________________________________________________________________

City,State,Zip_________________________________________________________

Additional information call (716) 845-4579 or fax (716) 845-8806