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Other Submission Cover Sheet
New Age Civilization of the 3rd Millennium: the age of global co-operation and symbiotical relationships theme A Vision to Caring for Life and Earth August 17-22, 2004
Ms. Mr. Mrs. Dr. First name: ________________________________________ Last Name: _____________________________ __________________________________________________________________________________________ Title/Position: ______________________________________ Department: ____________________________ Organization: ______________________________________________________________________________ Address: __________________________________________________________________________________ City: ____________________________________________________________ Province/Territory: _________________________________________________ Country: _________________________________________________________ Postal Code: _____________________________________________________ Telephone: _______________________________ ext: _______________ Fax: ________________________ E-mail: __________________________________________________ Website: _________________________________________________ Sector: Federal Government Provincial Government Municipal Government Corporate Academic NGO Media Student Other (please specify): ____________________________________________________________________ Your message: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________
Return your completed form to: Germain Dufour Project Officer Telephone (250)- 754-0778 Postal address Global Dialogue 2004 186 Bowlsby Street, Nanaimo, BC, Canada V9R 5K1 Electronic mail General Information: gdufour@globalcommunitywebnet.com Webmaster: gdufour@globalcommunitywebnet.com websites: http://globalcommunitywebnet.com/gdufour/ http://globalcommunitywebnet.com/globaldialogue2004/index.htm Back to top of the page |
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