LAST NAME:

FIRST NAME:

E-Mail:

Enter your address in the space below:

TELEPHONE: FAX:

The Hotel in which you wish us to arrange accomodation with in Puebla Hotel Colonial Hotel San Leonardo None

Type of room? Single Double

If you would like to share a room with another conference participant
please provide his/her name:

Date of Arrival: January 98 Departure: January 98

Are you a student? NO YES

Are you likely to attend the reception? YES NO

Are you likely to attend the Conference dinner? YES NO

Please submit the completed form before December 8, 1997.