Registration

2013 ILA Regional Conference Registration
Registration to the conference needs credit card information after clicking submit button

Name and Institution

Title

Name

Last Name

Institution

Position

Address and Contact Details

Address

Address Line 2

City

State / Province

Zip Code

Country

Phone

Fax

Email

Conference Participation Details

Participant Category

If Member which Branch?

Number of Accompanying Person and Names

Do you need an invitation letter for visa purposes?

No Yes

Dietary requirements

Hotel Booking?

I will make my own hotel reservation I will take advantage of the recommended hotels and book via the conference website

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