REGISTRATION FORM:

COST: $10.00 (includes lunch and snacks).

          Payment must be received by October 20, 2005.

No registration at the door.

(Early registration guarantees the space for the conference)

Make checks payable to : “Children’s Hospital Los Angeles-PKU Adults”

and mail to :                  Malathy Ramanujam

                                      5417, Carmelynn Street, Torrance, CA 90503

Children - 8 years (willing to follow directions and work in groups) and above can participate. Sorry no childcare available.  Please remember that participants are responsible for bringing their own “formula” if on the special diet and consuming it. No additional supervision is available.

For more information please contact Malathy Ramanujam at 310-371-8861or email to lopro@webuniverse.net

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Family Name: ________________________________________________________________

Address: _____________________________________________________________________

Telephone: _________________________E-mail____________________________________

List of all in the family attending:

Please remember to bring your own “formula” if on the special diet.

# of persons attending _______________X $10.00                                      = ________