Rencontres de Moriond
January 31st, 2019
(hotel reservation is made from this application form)

* fields are mandatory

Moriond Session: * 
Gender: * 
Family Name: * 
First Name: * 
E-mail: *
Professional Status: 
CNRS employee? 
(french institutions only) 
Is this your first attendance? 
Are you: 
Field of interest:

1. Affiliation

Home Institution: *
Street/Bldg: *
City: *
Postal code: *
Country: *
Your Phone: 
Portable Phone: 
Billing information: 
(please indicate here any specific information needed for your invoice)

2. Hotel Reservation
(reminder: hotel reservation is made exclusively by the conference secretariat)

Date of birth:  Place of birth:  Nationality: 
Twin room to be shared with: 

If you wish to have a single room, please mention it  
if Yes, please tick here to accept the 175 Euros supplement   

Please note that due to the limited number of single rooms available, when requested they will be attributed in priority to senior participants. A waiting list will be created and the remaining ones will be given the week before the conference by order of registration. 

Will you be accompanied : 

> by your spouse/partner?
First Name: 
Date of birth: 
type of bed
> by your children?
Child 1  Name: 
First Name: 
Date of birth: 
Child 2  Name: 
First Name: 
Date of birth: 
Child 3  Name: 
First Name: 
Date of birth: 

3. Arrival / Departure

Will you use the conference bus:
from Geneva airport to La Thuile? 
from La Thuile to Geneva airport? 

4. Permanent address for proceedings shipping (after september)
(if different from above)

Postal code: