SciTeCC Conference

REGISTRATION


Title (Ex: Dr./Mr./Ms.):
Fisrt Name:
Last Name:
Position:
Office or Department:
Company/Agency/Institution:
Telephone Number(no dash):	Ext.
Other Telephone Number(no dash):
Fax Number(no dash):
Email:
Address:

City:
State:
Country:
Zip Code:
Web Page:

Please fill the following information:


I want the Certificate of Continuous Education (You must pay $50 in Cash, Check or Money Order to the Universidad de Puerto Rico at the time of registration in the activity)* *We will not accept payments in advance or after the activity. The Certificate of Continuous Education will be sent by regular mail to the people that make the payment during the morning registration and CoHemis certifies that you attended the Conference.


I do not want the Certificate (Free Attendance)