AEAS 12 REGISTRATION

Association of Egyptian-American Scholars, Inc. http://www.aeascholars.org Founded in the United States and Canada in 19...

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Association of Egyptian-American Scholars, Inc. http://www.aeascholars.org Founded in the United States and Canada in 1974

Dept. of Pathobiological Sciences, University of WisconsinMadison, 1656 Linden Drive, Madison, WI C/O Dr. Adel Talaat

39th, Annual Conference, Dec. 25 - Dec. 27, 2012 Cairo - Egypt REGISTRATION FORM Name:_ __________________________________________________ Address:_ ________________________________________________ Institution: _________________________________________________ Phone/s: _______________

Fax: _________________

E-Mail:____________________________ Participation Desired: Attendance (_ )___, Discussant_____, Moderator_____, Paper______, Proposal: _____ Paper/ Proposal (Title)_____________________________________ Will Attend the Banquette: _______ Participant from USA / Canada_____ Fees: Free Conference Registration Awards Banquette US $65 Participants in Egypt_____ Fees: Free Conference Registration Awards Banquette LE 300 Please mail this form to AEAS Secretary, Dr. Adel Talaat at [email protected] Mail Cheques for the Awards Banquette to AEAS treasurer (Dr. Mohamed Hegab, 3 Utah, Irvine, CA 92606, E-mail Abstracts and Proposals to (Dr. Mohamed Attalla E mail address: [email protected]