Preregistration for
The Lodz Symposium -- June 21-26, 1999

Pre-Registrants who have used this form

  1. Name:

    Sex: Female Male

  2. Internet address (if available):

  3. Mailing Address:

  4. Would you like to give a 20-minute talk? Yes No

    Title of your lecture:

  5. Would you like to attend the banquet? Yes No

  6. Additional Information (roommate, accompanying persons, etc.)
    or have us send to you (driving directions or map of Lodz, etc)

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