ICCOSS XVIII & SMAOSS I |

SMAOSS - REGISTRATION FORM

Title: Prof. Dr. Mr. Ms. Mrs.
Last name: First Name:

Mailing Address:

Zip Code: Country:

Fax: Telephone:

e-mail:

Registration Fees

	before June 1, 2007	after June 1, 2007
Full registration	$300	$350
Student registration	$200	$250
Accomp. Person(s)	$100	$100
Excursion	$TBA	$TBA

Accompanying Persons:

Accompanying person(s) fees cover the welcoming reception, coffee breaks, and the banquet. The cost of the excursion will be the same as that for registrants. Please indicate the number of tickets required.

For Payment information, please contact Prof. Graciela Diaz de Delgado via e-mail: diaz@ula.ve or iccoss18@ula.ve

Do you intend to present a Paper?

Type of presentation:

Please provide a tentative title for your presentation

Do you intend to publish your contribution in the Conference Proceedings

Accomodation Form

For Student participants, please provide a certification by your research advisor