| Personal Information |
| Title and/or position: |
<%Response.Write (title)%> |
| *First Name: |
<%Response.Write (firstname)%> |
| *Last Name: |
<%Response.Write (lastname)%> |
| Company or Organisation: |
<%Response.Write (company)%> |
| Postal Address |
| Address Line 1: |
<%Response.Write (address)%> |
| Address Line 2: |
<%Response.Write (address2)%> |
| City/State: |
<%Response.Write (state)%> |
| Postcode: |
<%Response.Write (postcode)%> |
| Country: |
<%Response.Write (country)%> |
| |
| Telephone: |
<%Response.Write (telephone)%> |
| Fax: |
<%Response.Write (fax)%> |
| *Email: |
<%Response.Write (email)%> |
| |
Why would you benefit from attendance at this symposium? |
| |
<%Response.Write (benefit)%> |
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Have you submitted a paper to this symposium?
<%Response.Write (" ("&paper&") ")%> |
| |
Estimate of total cost of participation (please convert to US dollars):
|
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Registration fee: |
<%Response.Write (fee)%> |
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Hotel accommodation - name of hotel: <%Response.Write (namehotel)%> |
<%Response.Write (hotel)%> |
|
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Travel costs (explain):
<%Response.Write (tcoste)%> |
<%Response.Write (cost)%> |
| |
| TOTAL: |
<%Response.Write (total)%>
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