Please fill out this page and submit it by Email or Fax to Katherine Montague (see below for address):
 

Your name: __________________________________________________

Affiliation:___________________________________________________

Address:          ________________________________________________

                  ___________________________________________________

                  ___________________________________________________

Tel. number:      _______________________________________________

FAX number:       ______________________ E-mail:_________________
 
 
Please enclose a copy of your curriculum vitae and a letter describing your experience with linkage analysis and/or statistical genetics.  If you are working on any studies or development of methods, please explain.  Please be sure to include how you think you will benefit from this course.  In addition, briefly explain your experience with computers (DOS, Unix, Internet, programming languages, no previous experience, etc.).

To take this course you should feel comfortable using DOS, as well as being familiar with Unix and the Internet.  If necessary, please make sure you acquire these skills before attending the course.
 

Date: __________________________
 

Please return application to:

Katherine Montague
Rockefeller University
1230 York Ave, Box 192
New York, NY 10021-6399
Fax (212) 327-7996
Tel. (212) 327-7979
e-mail: montagk@rockvax.rockefeller.edu

OPTIONAL INFORMATION

This course is supported by the NIH.  They request that we provide the following information.  It is appreciated if you would supply us with this optional information.

Gender: ___Male __Female

Ethnic Background:  ___American Indian or Alaskan Native ___ Asian or Pacific Islander
                                ___Black, not of Hispanic Origin____Hispanic___White, not of Hispanic Origin