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| **REGISTRATION FORM**                                                 |
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| **FDA/CVM**                                                           |
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| **Public Meeting**                                                    |
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| **Animal Feed Safety System (AFSS)**                                  |
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| **April 5-6, 2005**                                                   |
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| **Crowne Plaza Hotel**                                                |
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| **655 North 108^th^ Ave.**                                            |
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| **Omaha, NE 68154**                                                   |
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| > **NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\  |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
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| **PREFERRED FIRST NAME ON                                             |
| BADGE                                                                 |
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| **ORGANIZATION:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
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| **ADDRESS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\       |
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| **\_\_                                                                |
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| **\_\_                                                                |
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| **\_\_                                                                |
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| **TELEPHONE                                                           |
| NUMBER                                                                |
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| **FAX                                                                 |
| NUMBER:\_\_\_\_\_\_\_\                                                |
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| **E-MAIL                                                              |
| ADDRESS:\_\_\_\                                                       |
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| > **Return this Form by March 11, 2005 to:**                          |
| >                                                                     |
| > **Ms. Brenda Boateng, FDA/CVM HFV-220**                             |
| >                                                                     |
| > **7519 Standish Place, Rockville, MD, 20855**                       |
| >                                                                     |
| > **Telephone: (240) 453-6850 Fax: (240) 453-6882**                   |
| >                                                                     |
| > **E-mail: brenda.boateng@fda.gov**                                  |
| >                                                                     |
| > **Please remember that room reservations must be made directly with |
| > the Crowne Plaza Hotel, at telephone number 402-496-0850. When      |
| > making reservations, please refer to the \"FDA Public Meeting", to  |
| > receive the group discount rate. Reservations must be made by March |
| > 11, 2005 to receive this rate.**                                    |
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