Information Request Form

Section:	Main.A1. CORP. INDEX. I-Im.Immune Network Ltd/P.2003. 09.04.2003. (AD)
Code:	61551
Product:	Canada. I
Company or Organization:
Contact's name *:
Position:
E-mail:
Mailing address:
Phone number:
Fax number:
Fields of interest:	ALLIANCE
* If you are not linked to any company or organization complete at least this field