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              Surname ..................................Degree ...................................
 Institution ..............................
 Address ..................................
 Telephone ............. Fax ..............
 I'm going to: take part in the Conference
 Title of the paper .......................
 Data: ....................................
 
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              Name .............................Position .........................
 ..................................
 ..................................
 .. E-mail ........................
  submit a paper
 ..................................
 Signature ........................
 
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