6^th PanPacific Connective Tissue Societies Symposium

November 30 – December 5, 2005

 Hilton Waikoloa, Hawaii

Registration            $500    (until 10/30/2005)  after that $550                                             _500.00

 Welcome Banquet, guests (included for attendees) $75 x No. of guests ___                       ______

 Tropical Dinner                                             $75 x  No of participants ___                       ______

 Snorkel Sail                    fee to be announced       x  No of participants ___                       ______

Total registration payment                                                                                                   ______

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Mail or fax the registration form to:

Do NOT send credit card information by email!

6^th PanPacific Connective Tissue Societies Symposium

Research Center, Shriners Hospital for Children

3101 SW Sam Jackson Park Road

Portland, OR 97239

USA

Fax:  503-221-3451

Lodging:                       Please indicate the room category   _____________

                                    Sharing room with         _______________________

                                    Date of arrival                                    _____________

                                    Flight Number  (of arrival)                  _____________

                                    Date of departure                               _____________