Mail-in form.

Please mail in the information requested below with your payment, or send the following information to alice@chem.ucla.edu

Alice, keeper of the list, will briely acknowledge each email or each mailed-in registration, if an email address is included. If you do not receive an acknowledgement, please get in touch by email!

DO NOT EMAIL CREDIT CARD INFORMATION.

Payments to attend the Reception/Dinner must be a separate transaction from any donations to The Christopher S. Foote Fellowship Fund.

Please write the designated fund number (in color, below) in the memo section of your check, or when you send in your credit card transaction. Payment can be accepted on the evening of the event, but reservations must be made in advance.

Send your reply to

The Favor of a reply is requested by October 1, 2005.

___I/we will attend the Poster Session

___I/we will attend the concert

___I/we will attend the symposium and luncheon

___I/we will attend the reception and dinner ($50 per person)

Name(s)___________________________________________________

Address____________________________________________________

City____________________________State______________Zip_______

Phone__________________________e-mail_______________________

Please choose from the following three entrees:

___Grilled Amalfi Salmon - Grilled filet of fresh Pacific salmon with ginger citrus sauce, served with herbed orzo and sauteed asparagus

___Mayan Banana-Wrapped Chicken - boneless chicken breast filled with cotija cheese, rubbed with achiote paste and bakedf in banana leaves. Served with cilantro rice and grilled seasonal vegetables

___Vegetarian.

For Dinner Reservations:
_____Please accept my check made payable to UCLA Foundation, Fund #61400

_____Please charge my: ___Visa ____Mastercard ___AMEX ____Discover

Card Number___________________________Exp. Date________________

Cardholder Signature_____________________________________________

************************************************************************************************************************************************

The Christopher S. Foote Fellowship Fund
I wish to make a tax deductible contribution to The Christopher S. Foote Fellowship Fund in
Organic Chemistry.

_____Please accept my check made payable to UCLA Foundation, Fund #3805
_____Please charge my: ___Visa ____Mastercard ___AMEX ____Discover
Card Number___________________________Exp. Date________________
Cardholder Signature_____________________________________________