INTERNATIONAL NAPOLEONIC SOCIETY REGISTRATION FORM

5 downloads 766 Views 80KB Size Report
INTERNATIONAL NAPOLEONIC SOCIETY. Twelveth International Napoleonic Congress. NAPOLEON AND REVOLUTIONS AROUND THE WORLD.
INTERNATIONAL NAPOLEONIC SOCIETY Twelveth International Napoleonic Congress

NAPOLEON AND REVOLUTIONS AROUND THE WORLD Parque Central Hotel

-

Havana, Cuba, July 7-11, 2014

Please complete this form and either email it or fax it back as soon as possible. For questions, please use email: [email protected], phone (416)342 8081 or fax (416) 368 2887.

REGISTRATION FORM ______________ Title (Mr, Ms, Dr) : __________________ Spouse /Companion : _____________ Street Address :

_____________ Last name :

_____________ First Name :

__________________ Middle Name/Initial :

______________________________________________ Others attending with you, not separately registered : _______________ City :

___________________ Phone :

_______________ Fax :

___________________ Date arriving in Cuba :

__________________ Date Leaving Cuba :

_______________________ Province/State Country : _______________________ E-mail : ___________________ Name of Hotel :

______________________________________ Title of Paper : __________________________________________ Special requirements for presentation (e.g. overhead projector, LCD projector) :

Author Release Form All presenters who wish their paper published must give authorization to the INS I accept the invitation of the International Napoleonic Society to present a paper to the twelfth International Napoleonic Congress in Cuba, and will comply with the technical requirements set forth in the Call for Papers. I authorize the International Napoleonic Society to publish my paper in any Napoleonic Scholarship, other publications or the INS Website, and/or to use it in a podcast/DVD of the Congress. ________________ Print Name :

______________ Sign Name :

________________ Date :