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REGISTRATION FORM

 

INTERNATIONAL SOCIETY FOR INTERCOMMUNICATION OF NEW IDEAS

 

EIGHTH INTERNATIONAL CONFERENCE

WAGENINGEN, THE NETHERLANDS

August 24-27, 2005

 

 

Name

 

Position

 

Affiliation

 

Address

 

 

 

Telephone

 

Fax

 

E-mail

 

Home address

 

 

 

Telephone

 

Fax

 

E-mail

 

Spouse or Guest of participant

Name

 

Preferred mailing address: affiliation/home (circle one)

 

Title of paper

 

Co-author(s): Write name(s) and affiliation(s)

 

 

 

 

 

 

Area

 

 

Besides presenting a paper I wish to:

Chair a session: Yes/No                        Discuss a paper: Yes/No

 

 

WAY OF PAYMENT:

 

q       By Bank:

Stichting BEOO,

Eekmolenweg 4,

6703 AM Wageningen,

The Netherlands,

accountnr: 686242440,

IBAN: NL64 INGB 0686 2424 40;

BIC: INGBNL2A,

Bank: ING Bank

Address: Molenstraat 142,

6711 AX Ede,

The Netherlands.

 

q       By Credit Card

           

 

 

 

0 EuroCard/MasterCard                            0 Visa                                     0 American Express

 

Card number:

 

 

 

 

 

 

 

 

 

 

 

 

Expiry date:

 

 

 

 

 

 

 

 

 

 

 

 

 

Card holder’s name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature:

 

 

 

 

Please return this Registration Form to:

 

Ms. Annelies Coppelmans

Wageningen University

Dpt of Economics of Consumers and Households

P.O. Box 8130

6700 EW Wageningen

phone : +31 317 485455

fax : +31 317 485373

e-mail : annelies.coppelmans@wur.nl

 

 

Signature : _________________________________

 

Date : _____________________________________