Registration Form

17th ANNUAL MEETING

JAPANESE LANGUAGE TEACHERS ASSOCIATION

OF

NEW ENGLAND

Saturday, August 23, 2003

8:00 - 5:00

Faculty Club, Massachusetts Institute of Technology

Cambridge, MA

Name: __________________________________________________________________

Title/Position: ____________________________________________________________

Affiliation: ______________________________________________________________

Address: ________________________________________________________________

________________________________________________________________________

Telephone: ______________________________________________________________

Fax: ___________________________________________________________________

Email: __________________________________________________________________

Home Address: ___________________________________________________________

Home Phone: ____________________________________________________________

Registration Deadline: Monday, August 4, 2003

Registration Fee: $30 (On-site registration will be $35)

Registration Fee includes a continental breakfast and a buffet lunch.

Please make your check payable to MIT, Foreign Languages & Literatures.

Please mail your completed form with payment to:

Yoshimi Nagaya

14N-305

Massachusetts Institute of Technology

77 Massachusetts Ave.

Cambridge, MA 02139