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\centerline{\bf  1999  Summer School on  Algebraic Geometry and Physics}
\centerline{\bf Marseille Luminy (France), September 6--14, 1999}
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\centerline{\bf PRE-REGISTRATION FORM}  \bigskip


NAME:

DATE OF BIRTH:

POSITION:

AFFILIATION:

E-MAIL ADDRESS:

POSTAL ADDRESS:

TELEPHONE:

FAX:


Do you apply for financial support? (please erase as necessary or check):  YES
NO

Do you apply for the waiving of the registration fee? (please erase as necessary
or check):  YES NO

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