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REGISTRATION FORM

The Royal Academy for Overseas Sciences and UN-Habitat are pleased to invite you to the Urban International Conference

Poverty in Medium and Small Cities of Developing Countries

Brussels, October 26, 27 and 28, 2009

Ms Mr

FAMILY NAME: --- FIRST NAME: --- FUNCTION/STUDIES: --- INSTITUTE/UNIVERSITY: --- --- POSTAL ADDRESS: --- ---

Monday, October 26, 2009 Tuesday, October 27, 2009 Wednesday, October 28, 2009

Will not attend.

Will attend.

Accompanied by……….persons.

Will not attend.

Will attend.

Accompanied by……….persons.

Will not attend.

Will attend.

Accompanied by……….persons.

Registration is free and can be faxed (00 32 2 539 23 53), e-mailed (kaowarsom@skynet.be) or sent to the Royal Academy for Overseas Sciences, Defacqzstraat - rue Defacqz 1/3, 1000 Brussels,

Deadline: 20 October, 2009

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