IFID - SECOND ANNUAL CONFERENCE
ON PERSONAL RISK MANAGEMENT
November 21, 2002

Please fill out form, print web page with data entered and fax to 416-348-9759
or mail form to: Program Manager,
The Fields Institute, 222 College Street, 2nd Floor, Toronto, Ontario M5T 3J1
For further information contact the Fields Institute Program Coordinator at cim@fields.utoronto.ca


  Title Status  

First & Last Name

Affiliation
Department
Address
City Country
Prov./State Postal/Code Zip
Email Phone  

REGISTRATION FEES:
$55 (CDN) includes GST, lecture notes and papers, a light lunch, coffee and snacks. ( GST#89601 1459 RT0001)
Cancellation Fee: please be aware that there is a $20 charge for cancellations to cover administration costs.

PAYMENT: Full payment must accompany this form
Payment method:
(If paying by cheque or money order,please make payable to "The Fields Institute".)
Card Number:         Expiry Date:    /

Name on Card:________________________________________ 


Signature:_____________________________________________
Comments and Special Needs

Fill out form, print web page with data entered and fax to 416-348-9759
Email confirmation will be sent on receipt of this form
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