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					                                                                                           REGISTRATION FORM


 Ramsey Lake Road
 Sudbury, Ontario, P3E 2C6
 Canada                                                                           INTERNATIONAL CONFERENCE ON LANGUAGE AND TERRITORY
 Phone: (705) 675-1151
 Fax: (705) 675-4885



Name                                                                                                   Northern Countries: Countries other than
                                                                                                       those in Africa (except South Africa), in
Business Name                                                                                          Central and Eastern Europe, in Southeast
Address                                                                                                Asia, in the Caribbean, and in Central and
                                                                                                       South America.
City, Province, Postal Code
Country                                                                                                Southern Countries: Countries in Africa
                                                                                                       (except South Africa), in Central and
Phone Number                                                                                           Eastern Europe, in Southeast Asia, in the
Email                                                                                                  Caribbean, and in Central and South
                                                                                                       America.


        NUMBER     DESCRIPTION                                                                                          PRICE            TOTAL

                   Registration to the Conference (Professors, Researchers residing in Northern Countries)              150 $

                   Registration to the Conference (Professors, Researchers residing in Southern Countries)              100 $

                   Registration to the Conference (Students residing in Northern Countries)                               75 $

                   Registration to the Conference (Students residing in Southern Countries)                               50 $

                    Per Day Registration to the Conference        Specify which day :                                     75 $

                    Registration to the First Nations Dinner and Musical Performance                                      35 $

                    Registration to the closing Banquet and Musical Concert (if not registered to the Conference)         75 $

                    Registration to the closing Banquet and Musical Concert (if registered to the Conference)             35 $

                                                                                                          TOTAL AMOUNT

 Payment Method
     MoneyGram/Western Union            Reference Number:
     Cheque
     Credit Card
                Visa                    Number:                                                          Expiry Date:
                Master Card             Number:                                                          Expiry Date:

 If paying by Credit Card, MoneyGram or Western Union, save the file and send it as an attachment by email to c2010@laurentian.ca, or
 fax it to (705) 675-4885. If you paying by cheque, make your cheque payable to Language and Territory Conference, and send it with the
 registration form to:

 Ali Reguigui and Julie Boissonneault
 International Conference on Language and Territory
 Laurentian University
 Ramsey Lake Road
 Sudbury, Ontario, P3E 2C6, Canada

                                                   WE THANK YOU FOR YOUR PARTICIPATION

				
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