Registration Form

Please mark and copy this form, paste it into a Microsoft Word file, complete the details, and send it as an email Attachment to: nbureu@dal.udl.es

CanaDays

University of Lleida, Spain, 26–28 May 2005

Deadline for Registration: April 30, 2005.

Family Name: ………………………………………………………................................................

First Name: ………………………………………………………….................................................

Identity Card Number (DNI) or Passport number: ……………………………..............................

Home address: ………………………………………………………….............................................

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Email address: ………………………………………………………….............................................

Phone number: …………………………………………………………............................................

University (if applicable): …………………………………………………………...............................

Present status (please replace the appropriate box ¨ with a X):

¨ university teacher

¨ schoolteacher

¨ student

¨ other (please specify) ………………………………………..................................................

I have formally applied ¨ / I do not intend to formally apply ¨ for academic convalidation of this conference.

I agree to pay a participation fee of 24 Euros, to be paid in cash at the CanaDays reception desk at the University of Lleida, 25/26 May 2005.

I wish to take part in the Hyde Park Corner; following is a summary (100–150 words) of my proposed presentation, together with a ‘biosketch’ (to be used by the chairperson as an introduction to the spoken presentation).

(A) Brief note about who I am:

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(B) Summary of proposed presentation

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