REGISTRATION FORM

GEBCO-Meetings, June 14th - June 23rd 2006

PERSONAL DATA

FIRST NAME: SURNAME:

ORGANISATION or INSTITUTION:

ADDRESS:

CITY: STATE / PROVINCE:

ZIP CODE: COUNTRY:

PHONE: FAX:

E-MAIL:

ARRIVAL

DATE (day/month/year): TIME (hh:mm): : LOCATION:

BY TRAIN AIRPLANE CAR OTHER:

DEPARTURE

DATE (day/month/year): TIME (hh:mm): : LOCATION:

BY TRAIN AIRPLANE CAR OTHER:

REMARKS

The following information is needed as we wish to plan the side programme of the conference as best as possible and therefore need to be aware of any special arrangements necessary during excursions or meals. Thank you for your help!

Please check where applicable!

VEGETARIAN DIABETIC OTHER:

PHYSICAL INFIRMITIES or HANDICAPS:

ACCOMPANIED BY

PERSONAL DATA

FIRST NAME: SURNAME:

ARRIVAL

Arrival details as above Different arrival details (Please fill in the following fields)

DATE (day/month/year): TIME (hh:mm): : LOCATION:

BY TRAIN AIRPLANE CAR OTHER:

DEPARTURE

Departure details as above Different departure details (Please fill in the following fields)

DATE (day/month/year): TIME (hh:mm): : LOCATION:

BY TRAIN AIRPLANE CAR OTHER:

REMARKS

Please check where applicable!

VEGETARIAN DIABETIC OTHER:

PHYSICAL INFIRMITIES or HANDICAPS: