Name Last:_______________________  First:_______________________ Initial _________

Institutional Affiliation: __________________________________ (For your name tag)
Dr. ___ Ms. ___ Mr. ___ None ___ (For your name tag)

Mailing Address    ______________________________

                             ______________________________

                             ______________________________

Telephone: (______) _______________   FAX: (______) ______________   e-mail: ______________________
 

Fees	Postmark by April 2, 1999	Postmark after April 2, 1999	Amount
SBN Member registrationa (includes post-docs)	$170	$195	$________
Nonmember registrationb	$220	$245	$________
Graduate Student membera	$75	$100	$________
Graduate Student nonmemberb	$125	$150	$________
Undergraduate registration	$75	$100	$________
Additional banquet ticketc	$ 40	$ 40	$________
Tour of Monticello	Number of tickets = ________	X $15 =                                  $________

Registration fees include opening reception/registration, morning and afternoon coffee breaks, poster session refreshments and banquet dinner.
                                                                                                                                                TOTAL AMOUNT ENCLOSED $________________
Check here if you prefer a vegetarian banquet meal: _______
^a If you have paid 1999 SBN dues or if you include your renewal dues (as a separate check made out to SBN membership) with this form.
^b New members may receive membership registration rate by including a Membership Application, c.v., and membership dues (as a separate check made out to SBN membership) along with registration fees. (http://www.sbne.org )
^c Use this only to purchase additional banquet tickets. One banquet ticket is included in the registration fee.
Payment: Fees are listed in US dollars. Fees are payable by check in US$ made payable to: Society for Behavioral Neuroendocrinology.

Mail to:     SBN 1999 Annual Meeting
                   Department of Biology, Gilmer Hall
                   University of Virginia
                   Charlottesville, VA 22903-2477