XXXIXth RENCONTRES DE MORIOND
ELECTROWEAK INTERACTIONS AND UNIFIED THEORIES
http://moriond.in2p3.fr/EW/2004
La Thuile
Aosta Valley, France
March 21-28 2004
Important remark: Talk
requests should NOT be made through this administrative form, but sent by email
to the program committee, as described in section III.3 of the bulletin (see
Contribution Form).
PLEASE INDICATE CLEARLY YOUR NAME, FIRST NAME AND
COMPLETE ADDRESS OF YOUR INSTITUTION ON THIS FORM!
Mr Ms Name
....................... First
Name ........
Date of birth
................... Professionnal status ..........
Nationality ..................................................
Is it your first
attendance?............................
Experimentalist Theorist
Collaboration
.....................................................
Field of
interest...................................................................
HOME INSTITUTION ADDRESS (1) .....................................
...................................................................
...................................................................
Phone
: ..............................................
Fax
:
................................................
E-mail :
..............................................
INSTITUTION MAILING ADDRESS
(2)....................................
...................................................................
...................................................................
Phone
:
..............................................
Fax
:
..............................................
E-mail :
..............................................
Which institution should appear on all the
conference documents ? 1 or 2
HOME ADDRESS :
................................................
...................................................................
...................................................................
Phone :
..............................................
Fax :
................................................
Will you be accompanied :
By your spouse
: Name & First Name
..............................
By your children :
First Name .................... Age
...........
First Name .................... Age ...........
First Name .................... Age ...........
If you wish to have a single room, please mention it
(suppl. of 140 Euros) Yes No
If you wish to share a double room, please specify
:
Smoker
Non-smoker
What will be the approximate time of your arrival on
Sunday March, 21st : by train ....... by car ......
by plane ......
Will you use the conference bus :
On Sunday March, 21st from Geneva airport to La Thuile
at 13 h 30:
No
Yes Number of seats ......
On Sunday March 28th from La Thuile to Geneva airport
at 12 h 30:
No
Yes Number of seats ......
Please return this registration form as soon as
possible to :
Claude
Barthelemy
Rencontres
de Moriond
LPT -
Batiment 210
Universite
Paris-Sud
91405 Orsay Cedex
FRANCE
Phone : 33 (0)1 69 15 82 16
Fax : 33 (0)1 69 15 82 87
E-mail moriond@th.u-psud.fr
DEADLINE FOR REGISTRATION : DECEMBER 30TH, 2003
NO
HOTEL RESERVATION WILL BE MADE WITHOUT THIS REGISTRATION FORM