Translating Evidence Into Policy:
Framing Research to Influence Policy(EPI 249)

Winter 2016

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☐ $618 (UC Affiliated) / ☐ $927 (Non-UC Affiliated)
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Return to Olivia De Leon by December 14, 2015: UCSF Campus Mail Box 0560 OR Training in Clinical Research Program, UCSF Dept. of Epidemiology and Biostatistics, 550 16th Street, 2nd Floor, San Francisco, CA 94143.
Fax: (415) 514-8150 Phone: (415) 514-8231 Email:

*The TICR Program will provide a refund (minus $75 withdrawal fee) only if students request this within 24 hours of the 2nd lecture in the course.

CREDIT CARD AUTHORIZATION FORM

PLEASE ENTER YOUR CREDIT CARD INFORMATION

OR if you prefer, contact Patty Tan by e-mail to provide information by phone or secure e-mail

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The issuer of the card identified on this form is authorized to pay the amount(s) shown above. I agree to pay such amount(s) (together with any other charge due theron) subject to and in accordance with the agreement governing the use of such card.

The TICR Program will provide a refund (minus a $75 withdrawal fee) only if students request this within 24 hours of the 2nd lecture in the course.

Please return form to: / UCSF – Department of Epidemiology & Biostatistics
Attn: Patty Tan
Phone: 415-514-8097
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San Francisco, CA 94143
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