CESNUR 2000 Online Registration Form

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Name (Last, First)
Organization
Street Address
City
State
Country
Zip or Postal Code
Telephone
Fax
E-Mail Address

Fees (in U.S. dollars):

Registration Fee, Regular $ 85.00; Registration Fee, Full Time Student $ 40.00
: Lunch Tuesday August 29 - $ 20; Lunch Wednesday August 30 - $ 20; Lunch Thursday August 31 - $ 20; Banquet "Religious Liberty East and West" - Wednesday August 30 - $ 40; Field Trip "Pre-Christian Revivalism in Latvia" - $ 50
: Total $

b) I will mail the details of my card with a printed and signed copy of this form
c) I want to register now and am sending a printed and signed copy of this form with an international cheque made out in the name of CESNUR d) I want to register now and am sending a printed and signed copy of this form with details of my bank draft ___ If you did not select option (a), send payment and registration forms to: CESNUR Via Juvarra 20 10122 Torino, Italy Fax +39 011 541905 If you select option (d) send bank drafts to CESNUR as follows Name of bank: San Paolo, Branch no. 35, Via Passalacqua 6, 10122 Torino, Italy Bank codes: ABI 01025 CAB 01174 Account number: 809

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