Home About Covance Investor Relations News Careers Contact Us Home  Advanced Search Drug Development Services Nonclinical Clinical Commercialization Industries We Serve Biotech Environmental Food & Dietary Supplements Pharma Research Vaccines Antibody Products Store Volunteer for a Study Investigators Information Library Animal Welfare Relevant Regulatory and Analytical Challenges for Food and Dietary Supplements 6th Annual Symposium Order Form Sponsored by Covance Laboratories and the UW Food Research Institute August 25-27, 2008 Covance Learning Center Madison, WI To receive your free copy of the symposium presentations on a flash drive, please fill out the information below. Fields with colored labels are required. Remember my personal info for future forms. Dr. Ing. Miss Mr. Mrs. Ms. Prof. Salutation First Name Middle Initial(s) Last Name Suffix Title Department Company Address 1 Address 2 Address 3 City Outside US/Canada Not Available Alabama Alberta Alaska American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Federated States of Micronesia Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Marshall Islands Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland & Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Palau Islands Québec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia U.S. Virgin Islands Washington West Virginia Wisconsin Wyoming Yukon Territory State/Province Province Outside North America United States of America Afghanistan Albania American Samoa Andorra Angola Anguilla Antarctica Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil Brunei British Virgin Island Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Colombia Comoros Congo Cook Islands Costa Rica Cote Divoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgystan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Guinea New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Panama Papua Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom U.S. Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Wallis and Futuna Islands Yemen Yugoslavia Zaire Zambia Zimbabwe Zip/Postal Code Country Phone Fax Email Address Please have a Covance Representative contact me. Yes No General Requests/Comments: Enter comments here. By supplying us with your email address, you are giving Covance Inc. permission to send you email messages regarding news articles, symposia, trade show events, newsletters, Covance services and other information that we believe you will find valuable. Covance Inc. agrees that we will not sell or share your information with any other sources, except to the extent needed for us to send you email messages (i.e. technology contractors). No, I prefer that you only use my information for the above inquiry.