register with interclass

the following form can be submitted electronically or faxed to [U.S] 617-864-7902.
It is important that you fill in your arrival and departure dates.

personal information

Please indicate the meeting for which you are registering:

 

name:

position:

company:

address:

city, state, zip code, country

telephone:

fax:

email:

assistant's name:

assistant's telephone:

upon registration you will be contacted by phone for your credit card information.

overnight accommodations

arrival date: time:
departure date: time:

occupancy:                   bed:                    smoking:

dietary or other request