PRE-REGISTRATION FORM

SEMINAR
Europe, against anti-Semitism
for a Union of Diversity

19 fvrier 2004
Immeuble Charlemagne
Salle S3
Rue de la Loi 170 Bruxelles

Personal details
Mr / Ms (delete as appropriate)
Family name:.......................................... First name:...............................................................
Position: ..............................................

Organisation: ................................................................................................................
Address: (number and street etc.)........................................................................................... .
Post-code:....................................... City:........................................................................ ..
Country: .......................................... E-mail:................................................................... ...
Tel:
Fax: ..

Date:..................................... Signature............................................

Please complete this form in block letters and return it by 15 February 2004
by fax to "Seminar Secretariat" at: +32-2-299.22.23 or +32-2-295.23.05
or e-mail to:

preregister.forseminar@cec.eu.int