REGISTRATION FORM

First International AMONET Meeting on

WOMEN IN SCIENCE

If you wish to participate, please fill in and return the form before the 25 of February, 2006.

• NAME:

• TITLE:

• MALE/FEMALE:

• AFFILIATION:

• ADDRESS FOR CORRESPONDENCE:

• E-mail ADDRESS:

• ARE YOU SUBMITTING AN ABSTRACT:

• ABSTRACT TITLE:

Please send this form electronically, by fax or standard mail, and remember to send the cheque for payment of the conferece fee.