Chairman`s Invitation
About the Congress
WAITING LIST
PROGRAM
INSTRUCTIONS TO PRESENTERS
ABSTRACTS
MAILING LIST
Committees
Guest Speakers
Accommodation and tours
General Information
Call for papers
Deadlines
The Sponsors
Registration
Registration Form
Contact
Print Poster
ΑΦΙΣΑ
ΕΛΛΗΝΙΚΑ - GREEK


Registration Form

 

THE  CONGRESS  IS  FULL

 

WAITING  LIST  IS  OPEN

 

REGISTRATION FORM

 

Please  FILL IN  or  CHECK  the following and return it  by post, fax or email to:

 

Prof. George Th. Pavlidis          Tel. +Fax: (-30) 2310 667795

Chairman, Congress Committee        E-mail:info@dyslexiaworldcongress.org

University of Macedonia

Thessaloniki, 54006  Greece

 

Title: Prof. œ Dr. œ  Mr œ  Mrs œ   Miss œ    Profession: …...………….....

Name:………………………..….              Surname: ……........................

Address:………......………………........................Post code:.............   

Country: ……………………….………Tel  (Mobile): .………….....

Tel(home):..............................................  Tel (work):....…...............…...

 Fax: …………………………….....            E-mail: …..………..………...

University  Teacher  œ   Researcher œ   Practitioner  œ     Administrator œ   Trainee œ   Psychologist œ      M.D. œ   LD  Specilist œ              

Special  Educator   œ         Teacher œ           Linguist œ   

Student œ     Parent œ  

Else (specify) ……………………............……….…………….........................

You are interested in:   DYSLEXIA    œ    LD  œ    ADHD   œ 

Reading  œ       Spelling  œ                  math  œ     Prognosis   œ        

Diagnosis œ    Treatment œ   psycho-social  œ     legislation   œ       

VERY GOOD  KNOWLEDGE OF  ENGLISH:   YES œ     NO œ 

Else  (specify) …………...........................................................................

Have you already sent your PAYMENT?   YES  œ    NO  œ

If  YES,  Please specify:   WHEN:  ..…... / ...….. / 2004   AMOUNT ...........

HOW:   Cheque œ  (# of Cheque…………….………………………….)   

Banker’s  Draft œ

 

Comments: …………………………………………………………………………..

 

The  Proof  of  Registration  is  your  Receipt  of  Payment.

 

 Date:  ……. /  …… /  2004

 

    Signature:………………............