Registration Form

Registration Form


Please type or print in block letters or tick [v] the information required in this form.
Please return it before the dead line of 30th June 1999.

Name and Title (Prof., Dr., Mr., Ms., etc.):_____________________________
Position :_______________________________________________________
Address :_______________________________________________________
______________________________________________________________
______________________________________________________________

Country : ______________________
Phone : ______________________ Facsimile : ________________________
E-mail : ______________________

I wish to attend the symposium as

[ ] an ordinary participant.
[ ] a contributor of a paper: oral[ ] / poster[ ]. The paper is titled:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

[ ] a participant of Field discussion at Bukit Soeharto

I am interested in

[ ] Forest Fires in Tropics
[ ] Effects of the impacts on soil, water and air environments, hydrology etc.
[ ] Effects of the impacts on forest animals, plants and fungi and their recovering processes
[ ] Rehabilitation techniques for degraded forests

I will accompanied by ___ persons, and prefer the accommodation in

Hotel _____________________ from ____ to _____ September 1999
Signature: ______________________

 

*: This form is requested to be sent by Fax (+62-541-39894) or by Mail (inside an
envelope. E-mail to toma@smd.mega.net.id is also available.)


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