Personal Information |
Title: |
<%Response.Write (title)%>
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*First Name: |
<%Response.Write (firstname)%>
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*Last Name: |
<%Response.Write (lastname)%>
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Affiliation: |
<%Response.Write (affiliation)%>
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Postal Address |
Address Line 1: |
<%Response.Write (address)%>
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Address Line 2: |
<%Response.Write (city)%>
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City/State: |
<%Response.Write (state)%>
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Postcode: |
<%Response.Write (postcode)%>
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Country: |
<%Response.Write (Country)%>
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Telephone: |
<%Response.Write (telephone)%>
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Fax: |
<%Response.Write (fax)%>
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*Email: |
<%Response.Write (email)%>
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<%Response.Write ("[ "&symposium&" ]")%>
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I plan to attend the short course |
<%Response.Write ("[ "&accompany&" ]")%>
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I shall be accompanied by :
<%Response.Write (accompanyname)%>
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other request: |
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<%Response.Write (oneri)%>
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