CSA Seminar Registration

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National Seminar
on
Environmental and Occupational Health:
Interface with Statistics
December 27, 2008
Name :______________________________________________________________________
Affiliation :______________________________________________________________________
Contact Address


:______________________________________________________________________
 ______________________________________________________________________
 ______________________________________________________________________
Phone number :______________________________________________________________________
E-mail :______________________________________________________________________
Whether member of CSA :______________________________________________________________________
Meal preference :    [_]   Vegetarian     [_]   Non-vegetarian


Date: ________________


___________________
(Signature)
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