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:_________________________________

$400 Registration fee is enclosed

(sorry, we can not accept credit cards) Please write check to

MISAHA

3855 Via Nona Marie, Ste. 102-C

Carmel, CA 93923

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