PEMRA 2012 Registration Form

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* Required information.
Confirmation number (Softconf registration): *
Title: *
First Name: *
Last Name: *
Affiliation/Organization *
Affiliation Dept/Lab: *
Phone: *
Fax: *
E-mail: *
E-mail (again): *
Country: *
Address: *
City/Town: *
Zip/Postal Code: *
VAT identification number (with country code): *
Registration Category *
Total Additional Pages (over 8 page limit/paper)
Additional Paper Fees (over 1 paper limit/author)
Additional Banquet Ticket
CLAWAR Membership Registration (1 year)