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REGISTRATION
ICID 19TH CONGRESS AND 56TH IEC MEETING
REGISTRATION FORM
Please complete in capital letters and return to address below
LAST NAME: _______________________ FIRST NAME: _____________________
TITLE (Circle the appropriate) MR. MRS MS DR PROFESSOR
PRESENT OCCUPATION: _______________________________________________________
EMPLOYER’S NAME: _________________________________________________
BUSINESS ADDRESS:
Street name/no.:______________________________________________________
city: ___________________ province/state: _____________________
postal code: __________________ country: _________________________
PHONE: ______________________________________________________________________
Country code region/city code number extension
FAX: _________________________________________________________________________
Country code region/city code number
E-MAIL: ______________________________________________________________________
PLEASE MARK ASAPPROPRIATE:
( ) I intend to participate ( ) I intend to present a paper
( ) I intend to exhibit ( ) I intend to participate in Tour
( ) I am an accompanying person A B C D E F G
( ) I will require hotel accommodation circle your choice
PLEASE RETURN TO:
National Organizing Committee
19th ICID Congress and 56th IEC Meeting
Beijing 2005
Telephone: 86-10-68415522 ext 6506
Fax: 86-10-68457179
Email: Beijing2005@cncid.org
REGISTRATION FEES
| Participants |
Registration before or on June 1, 2005 |
Registration after June 1, 2005 |
Full Participant
From Member Country |
US$ 800 |
US$ 850 |
Full Participant from
Non-Member Country |
US$ 850 |
US$ 900 |
Accompanying Person
Young Professional |
US$ 300
US$ 400 |
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