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Family
name: ________________________________________ Organization: ___________________________________ Email: _____________________________________ Fax:: _________________________ ISSCT Membership No (Delegates must be current members of ISSCT. See ISSCT website for Membership Forms): _________________________ I will present an oral communication: MAY BE YES NO Topic of presentation:_______________________________________________________________________________ Title (if available): _________________________________________________________________________________ I will present a poster: MAY BE YES NO Topic of presentation:_______________________________________________________________________________ Title (if available): _________________________________________________________________________________ Number of accompanying person(s): ____________ Arrival date (estimate): _________________________________________________________________________________ Departure date (estimate): _________________________________________________________________________________ Special Requirements – Dietary or other: _________________________________________________________________________________ |
