THIRD WORLD CONFERENCE FOUNDATION

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30th Annual Third World Conference Registration Form

First Name:
Last Name:
Address:
City:
State:
Zip:
Country:
Phone:
Email:
Fax:
Organizational Affiliation/University

Early Bird Registration (08/15/03----- 01/15/04)
Individual - $375.00 Student - $265.00

Registration Period (01/15/04-----03/06/04)
Individual - $425.00 Student - $295.00

Payment Method
Visa Master American Express Discover
Card Number: Expiration Date:

Third World Conference Foundation
1525 E. 53rd Street, Suite 435, Telephone: (773)241-6688/Fax: (773)241-7898
Chicago, IL 60615-4509
E-mail: twcfusa@aol.com