13th Himalaya-Karakoram-Tibet International Workshop Peshawar, Pakistan April 20-22, 1998

Pre-Registration Form

Personal Details (For visa/government clearance*, etc.):

Name: Last, First, Middle______________________________________________________________

Date & Place of Birth:_______________________________

Nationality:_______________________________

Passport No.: ____________________________________

Place/Date of Issue: __________________________________

*(Please attach a photocopy of first two or relevant pages of your passport)

Institution/Organization_____________________________________________________ _________

_____________________________________________________________________________ ________________

_____________________________________________________________________________ ________________

Mailing Address (if different from above):______________________________________________________________

_____________________________________________________________________________ ________________

_____________________________________________________________________________ ________________

Phone:_______________________________ , Fax:_______________________________

email:_______________________________

Oral Presentation (Tentative Title):

Poster Presentation (Tentative Title):

Field Excursion: Y/N?

Please mail this form as soon as possible, but not later than October 20, 1997, to the following address:

M. Asif Khan / M. Qasim Jan,
13th HKTIW,
National Centre of Excellence in Geology,
University of Peshawar,
Peshawar, Pakistan