APPLICATION FORM

FIFTH PERMANENT FORUM OF LATIN AMERICAN AND CARIBBEAN NETWORKS
                         Lima, Peru
                         April 1996

1. PERSONAL INFORMATION

   1.1. Last name:

   1.2. First name:

   1.3. Sex (m/f):

   1.4. Telephone (home):

   1.5. Nationality:

   1.6. Languages in which you are fluent:

   1.7. Smoke (yes/no):

   1.8. Special food habits:

   1.9. Other important information to ensure adecuate=20
        accomodations, meals, and transportion:


2. INSTITUTIONAL INFORMATION

   2.1. Name of your institution:

   2.2. Position:

   2.3. Postal address:

   2.4. Street address:

   2.5. E-mail address:

   2.6. Tel:

   2.7. Fax:


3. FORUM PARTICIPATION

   3.1. Please mark with an =93X=94 the Forum stages in which you plan=20
        to attend:
        () Strategic Planning Workshop       April 14-16
        () Paper Presentation                April 17-19
        () Peruvian Internet Debate          April 19 (afternoon)

   3.2. Have you applied or do you plan to apply for a partial
        scholarship in order to participate in this Forum (yes/no)?

   3.3. Will you present a paper in the Forum (yes/no)?

   3.4. How did you learn about this event for the first time?

   3.5. In which of the topics included in the Forum are you=20
        interested?

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                PLEASE, SEND YOUR APPLICATION FORM TO:
                        comite-foro@rcp.net.pe

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