Society for Whole Body Autoradiography
Membership Form
Last Name:____________________________
(Circle Title: Mr, Mrs, Ms, Miss, Dr, Prof)
First name:___________________________
Company:_______________________________________________
Address:
____________________________________ Telephone no:_______________
____________________________________ Fax no:____________________
____________________________________ E-mail:_____________________
____________________________________
Send Membership via FAX, Email or Postal Mail to:
Marissa Vavrek , SWBA
c/o Merck Research Laboratories.
WP 75B-200
770 Sumneytown Pike
West Point, PA
Phone: 215-652-3238
Fax: 215-993-1245
E-mail: : marissa_vavrek@merck.com