STOC 2014 Room Sharing Registration Form

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Fill-in your name, contact information, and arrival/departure date.

* Indicates required question

Name *

Your answer

Contact Information

Email *

Your answer

Address

Your answer

Phone

Your answer

Room requirements

Arrival date (mm/dd) *

Your answer

Departure date (mm/dd) *

Your answer

Gender *

Male

Female

Smoker *

Yes

No

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