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Conference Site
Maui, Hawaii
Administration

The Third

International World Congress on
Maxillofacial Prosthetics

June 17-20, 1998 � Torino, Italy

Conference Registration Form

Conference Fees

  Pre Registration
Prior May 15, '98		 Post Registration
After May 15, '98		 On-Site Registration
ICMP Member

$395

$475

$500
Non Member

$495

$575

$600
Resident

$295

$375

$400

This registration form is divided into the following sections:

Contents

bulletConference Registration
bulletTravel Request
bulletForm Submission
bulletAdministration Office

Return to ICMP Conference Page

Fill out the information in each section as requested. Upon completion, submit the form. You will receive a confirmation message through Fax or E Mail address.

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Conference Registration

Are you a ICMP member? Yes No

If you would like to be a member of the ICMP, please complete our membership application form: Membership Form

  1. Surname:


  2. First Name:


  3. Fill in the address you would like to receive your confirmation. 
    Street   
Suite    
City     
State/Province Country 
Zip/Postal Code
Telephone (include country/city code) 
Fax       (include country/city code)
E Mail
  4. Name of Practice:


  5. Will you be submitting an Abstract for Oral Presentation? Yes No
  6. Will you be submitting an Abstract for Poster Presentation? Yes No

  7. If yes, to Oral or Poster Presentation... Submit, Title of Abstract:



         You may submit your abstract by linking to: ICMP Abstract Form

  8. Comments:



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Travel Request

For information on discounted travel packages to your upcoming conference...

ICMP Conference Travel Page

Would you like to receive travel information regarding:

  1. Air Travel? Yes No
  2. Ground Travel? Yes No
  3. Hotel Accommodations? Yes No
  4. Other:

    If you requested travel information... please complete the following:
  5. Departure City:



  6. Destination City:



  7. Date of Departure: Time of Departure:

  8. Date of Return: Time of Return:

  9. Number of Passengers:

  10. Comments and Request:
    (List- preferred airlines, class of service, seating, etc.)

Return to Table of Contents

FORM SUBMISSION

Thank you for your participation. After completing the above registration form, click "Submit Form". We will process your registration and contact you for conference payment.

How did you find our web page?



ICMP Conference Administration Office

RES, Inc � P.O. Box 99119 � San Diego, CA 92169-1119
Electronic mail address Web Address Office phone FAX number
[email protected] http://www.res-inc.com (619) 272-1018 (619) 272-7687
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Copyright � 1995 RES, Inc. All rights reserved.
Revised: July 05, 1996.