Indaba - III

Registration Form

Title :
Initials :
Surname :
Department :
Organisation :
Postal Address :
Town / City :
Postal/Zip code :
Country :
e-mail :
Telephone :
Fax :
.
I will be accompanied by :
Preffered type of accomodation :	Single
	Shared
I would like to share with :
.
Type of presentation :	Oral Presentation
	Poster Presentation
Provisional Title :

Note that this form will funtion correctly only when used within Netscape or MSIE 4 version 4 or later.