DONATION

in support of the International Scientific Symposium

PARADOXICAL EFFECTS IN BIOPHYSICS AND MEDICINE

December 12-17, 2004

at Asilomar Cofnerence Grounds, PG, California

First and Last names:_________________________________________________ Title:__________________

Scientific Association:________________________________________________

Mailing address including country:______________________________________________________________

Business phone:_______________Home phone:_________________Mobil phone:___________________

Email:_________________________________ Web site:__________________________________________

MISAHA

3855 Via Nona Marie, Ste. 102-C

Carmel, CA 93923

I want my donation to be acknowledged at the Symposium __ and/or in MISAHA Newsletter__or not at all___

Your donation is deeply appreciated

REGISTRATION FORM

for the International Scientific Symposium

PARADOXICAL EFFECTS IN BIOPHYSICS AND MEDICINE

December 12-17, 2004

at Asilomar Conference Grounds, PG, California

First and Last names:_________________________________________________ Title:______________

Scientific Association:______________________________________________

Mailing address including country:__________________________________________________________

Business phone:___________ Home phone:____________ Mobil phone:___________

Email:_________________________________ Web site:_________________________________

MISAHA

3855 Via Nona Marie, Ste. 102-C

Carmel, CA 93923

Registration fee is refundable minus $50 if requested before December 1, 2004

Credit cards are not accepted.