REGISTRATION FORM

 

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