MT-DIW5 REGISTRATION FORM

Registration form along with payment is arranged together with the 15th EM 
Induction workshop, and so the payment for MT-DIW5 must be included in the 
general "PAYMENT FORM" for the 15th workshop.

Please send the attached registration form before May 15th 2000 to:

            Meta Marketing e Eventos Ltda.
            c/o 15TH WORKSHOP ON ELECTROMAGNETIC INDUCTION IN THE EARTH
            Av. Nilo Pecanha, 50 - grupo 1610  
            20044-900, Rio de Janeiro  
            Brazil  
            Tel: +55-21-2202097 or +55-21-5240676 
            Fax: +55-21-2202305
            E-mail: meta@domain.com.br 


-------------------- MT-DIW5 Registration Form (cut here) ------------------

Surname:___________________ First Name:______________________ Mr/Ms:_____

Affiliation:_____________________________________________________________

               __________________________________________________________

Address:_________________________________________________________________

City: _______________ Postal code: __________________ Country: __________

Phone: ___________________________________________

Fax: _____________________________________________

E-mail: __________________________________________

Preference of Hotel: 1.___________________________ 2.__________________________

Type of Room Requested (circle):  Single    Double    Triple 

Whom do you wish to share a twin or triple room with:___________________________

______________________________________________________________________________

If you have a physical disability, note any special arrangement required:_____

______________________________________________________________________________