| Last name: |
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| First name: |
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| Title: |
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| Institution: |
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| Address |
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| Number, Street, Apartment Number |
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| City, State |
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| Zip Code |
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| Country |
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| Phone number (include country and area code) |
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| Cell number |
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| Fax |
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| Email |
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| Third Conference Registration Fees |
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Participants of Canada, United States, Europe,
Australia and Japan |
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| Participants of other countries |
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$ 250 US |
| Students |
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$ 125 US |
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I do not want to participate in the conference, just workshops. |
| Gala dinner fee (June 4th) |
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Number of guests
(These persons will attend the conference dinner with the registered delegate) |
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Pre-Conference Workshops Feed
(June 1-2, 2010) |
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(The workshops can be attended without registering for the 3iccp2010) |
| Taller (choose workshop number) |
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| Participants from Canada, United States, Europe, Australia and Japan |
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$ 100 US |
| Participants from other countries |
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$ 75 US |
| Students |
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$ 50 US |
| Total payment must include all the fees of the different activities you have chosen |
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| Method of Payment |
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| Invoice Data |
| R.F.C. |
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| If you require an Invoice |
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Yes
No |
| Note: The invoice information will be the previous data. |
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| Conference registration is not guaranteed until payment is made in full |
