Young Local Universe
Rencontres de Moriond
La Thuile, Aosta Valley, Italy,
March 21 - 28, 2004

Registration form

Deadline for registration: February 15, 2004
Please note that no hotel reservation will be made without this registration form.

The fileds to fill in below are limited to 50 characters, with no (reasonably!) limit for Abstract.

First Name:
Family Name:
Institution:
Institution Address:
Street:
Zipcode, City
Country
Phone:
Fax:
E-mail:
Home Address:
Street:
Zipcode, City
Country
Phone:
Fax:
Citizenship :
Do you wish to present
a contributed paper? 		Yes  No
Oral presentation ? Oral  Poster
Title :
Abstract :
The oral contributions will be selected by the
ad hoc Program Committee chosen among the SOC members.
Will you need a financial (partial) support from YLU ? Yes  No
If you are younger than 35, please give here your age (necessary for the european grant)
Hotel reservation info:
Will you be accompanied by your spouse? Yes No
Her First Name:
Her Family Name:
Will you be accompanied by your children? Yes No
First Name:
Age:
First Name:
Age:
First Name:
Age:
If you wish a single room, please mention it here (suppl. of 140 Euro): Yes No
If you wish to share a double room, please specify Smoker/Non-smoker: Yes No
If you wish vegetarian meals, please indicate it here: Yes No
What will be the approximate time of your arrival on Sunday March, 28th:
By train (HH:MM):
By car (HH:MM):
By plane (HH:MM):
Will you use the conference buses ?
On Sunday March 21 from Geneva to La Thuile at 13:30: Yes No
Number of seats:
On Sunday March 28 from La Thuile to Geneva at 12:30: Yes No
Number of seats::

Now you can   or   your application.

This information will also be automatically e-mailed to you.

In case of problem, please contact: ylu@obs.ujf-grenoble.fr