UV Disinfection for Emerging and Developing Countries - June 7, 2012 Title:   Dr.    Mr.    Mrs.    Ms.  First Name: Last Name: Address:   Phone:   Email: Organization: Position: Registration Fees: IUVA and UNESCO IHE agreed to donate 1/3 of the registration fee to a UNESCO water project   Student fee - 0    Attendee (Non Student) - 300  Payment: Mail checks to IUVA - 1718 M Street, N.W. #276 Washington, D.C. 20036 For questions, please call 202-422-2445 (T) 202-318-4561 (F) Credit Card No.: Expiration Date: Name on Card:

This form was created at www.formdesk.com