REGISTRATION FORM (3rd ICDEA, Sept 1--5, 1997, Taipei)

Please, print or type

TITLE:(Please circle) Mr. Mrs. Dr. Prof. Jr.

FAMILY NAME: ________________ FIRST NAME: _________________________

MAILING ADDRESS: __________________________________________________

__________________________________________________

TELEPHONE:(with country code) ____________________________________

FAX:(with country code) __________________________________________

E-MAIL: __________________________________________________________

BADGE INFORMATION (please limit to 35 characters):

NAME TO APPEAR ON BADGE: _________________________________________

GUEST BADGE: _____________________________________________________

NAME(s) OF ACCOMPANYING PERSON(S): _______________________________

ACCOMMODATIONS:

I would prefer (please circle one): Single Room Twin Room
at ACTIVITIES CENTER OF ACADEMIA SINICA, TAIPEI
between AUGUST 30 and SEPTEMBER 6.

If you wish to share accommodation with another participant,

please indicate name(s): _________________________________________

ARRIVAL DATE:______________ ARRIVAL FLIGHT and TIME:_____________

DEPARTURE DATE:____________ DEPARTURE FLIGHT and TIME:___________

PS: If your stay period is outside the period Aug. 30-Sep. 6
and if there is no rooms at Activities Center, we will provide
the hotel information for you.

I AM INTERESTED IN MORE INFORMATION CONCERNING POST
CONFERENCE TOURS (please circle one): YES NO

SIGNATURE:________________________________ DATE:_________________