Application form - ISEND 2011

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Please complete and return this application form.

Surname * :

First name :

Affiliation (academic/organisation...) * :

Nationality :

Tel :

Mobile :

Fax :

E-mail * :

Address :

ZIP/Post Code :

City :

Country :

* obligatory reply

Individual farmer/cooperative producing dye plants or natural dyes

Business/industry producing natural dyes or pigments

Artist/Designer/Fashion Producer

Business/industry making, and marketing, products using natural dyes or pigments

Craftsperson making and selling work using natural dyes or pigments

Member of relevant association or NGO

Government representative

Please state below how you would like to participate in the symposium. (Final selection of papers, posters etc will rest with the organisers if there are too many to accommodate.) Please tick the relevant boxes and write brief descriptions where applicable, adding details under 'I have a suggestion for the Symposium' if necessary.

Il would like to :

Attend the Symposium

Offer a paper Title :

Display a poster Title :

Show a film Title : Time (mins) :

Demonstrate the following dyeing process :

Reserve a stall, and sell relevant products : Nature of products :

Have products considered for a fashion show
Please describe :

Have products considered for an exhibition
Please describe :

I have a suggestion for the forthcoming symposium
Please explain :

I wish to figure among the sponsors of the Symposium

Nature of the sponsorship :