Registration 2004

Drawing in Italy from May 6 to June 6 2004

Confidential

General Information

1. Surname
2. Name
3. Student No.

Date of birth:

1. Year
2. Month
3. Day

Present address

1. No
2. Street
3. Town
4. App.
5. Province
6. Postal Code
7. Tel Home
8. Tel Work
9. Fax no
10. E-mail

Occupation

1. University
2. Or Work
3. Employer

Health

Particular condition or diet (please explain)

Comments

Registration. A deposit of $350. money order or certified cheque, payable to Michèle Delisle, must accompany your application by October 31st, 2003. In the case of cancellation of inscription by the participant, $200. will be retained for administration fees. To allow all reservations in Italy, 25% of the balance ($850.) should be paid by December 5th, 2003. The rest, ($2,550.) is due for January 16th 2004 at the latest. Any cancellation made by the participant will not be refunded. The travel agency responsible of flight arrangements is offering cancellation policy.

P.S.: To be admitted foreign students have to pay the supplement for non-residents on the academic fees only.

I accept the conditions of this contract and certify I read them

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Name

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Signature

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Date

This Form must be sent to:

Michèle Delisle
230 Sherbrooke St. East, app. 202
Montreal, Quebec
H2X 1E1