The 19^th International Conference on Advanced Science and Technology University of Illinois at Chicago, Chicago, Illinois

ICAST 2004 September 18, 2004

PRE-REGISTRATION FORM

Deadline: Sept. 10, 2004

Last Name: ____________________ First Name: ______________________ M.I: ________

Affiliation: __________________________________________________________________

Address: ____________________________________________________________________

City: ____________________ State: __________ ZIP: ___________ Country: ____________

Telephone: ________________ Fax: ________________ E-Mail: ______________________

Registration Fee: Free

Please Note: $5.00 will be charged for a program book (abstracts) for late or on-site registration.

Parking stickers can be purchased at registration for $3.00/day

Please mail this form to:

Dr. Shih-Chang Chao

3006 S. Poplar Avenue

Chicago, IL 60608

Or e-mail to:

icast@elitegen.com

Or register on-line:

http://macapa.elitegen.com/