14th conference of surgeons of the South Caucasus countries
13-16 November, 2003, Tbilisi, Georgia

Russian

Registration form of a  participant

Surname                                   Name                                          Middle name                           

Title                                                    Occupation                                                        

Telephone                                  Fax                             Е-mail                                                 

Title of work/lecture (underline)                                                                                                                                                                

Form of presentation: Oral speech     Yes/No   Poster    Yes/No

Hotel reservation: 40$   Yes      100$   Yes   150$   Yes

Registration form and abstract should be submitted to the secretariat of the conference  by 30 November, 2003

Date:                                                          Signature: