Rolwaling Conference Online Registration

[Mountain Legacy ][Rolwaling Conference ] [Register by Email ]

















  

  
   1. Personal Data
  





   
  
   

    First Name 

   		

   
   
   

   Middle Name
   		

   

    
   

   Family Name 
   		

    
     
    

     Suffix

    		





     
     
      Female
       Male
      

      Gender
     		

 
     

      

     Title

     		


      
        










Address (Street, Number, Apt.) 











City 






State or Province








Postal ("Zip") Code 		




Country









Phone (e.g. 412-555-1212) 





Email Address 








2. Academic or Professional Affiliation












Name of Institution; City; Country












Department or Subsection






Affiliation







3. Details of Participation in Rolwaling Conference










Will you participate in the pre-conference trek to Tsho Rolpa? 

Yes  
No
Not sure












Do you wish to make a presentation? 

Yes  
No
Not sure






Do you require assistance in making hotel reservations? 

Yes
No
Not sure













4. Presentation






Abstract of Presentation (provisional)


   
















 
 

























 
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