Registration Form

XXXVIIth RENCONTRES DE MORIOND
The Cosmological Model
March 16-23, 2002 , Les Arcs, Savoie, France

Please send this registration form to :
Mr Christophe Nodé-Langlois
Rencontres de Moriond, BP 33
F-91192 GIF SUR YVETTE CEDEX , France
Phone : (33 1) 69 29 05 50 Fax : (33 1) 69 28 86 59
(or by E-mail to chrisnl@lal.in2p3.fr)


DEADLINE FOR REGISTRATION : JANUARY 15, 2002
NO HOTEL RESERVATION WILL BE MADE WITHOUT THIS REGISTRATION FORM

                         REGISTRATION FORM

PLEASE INDICATE CLEARLY IN CAPITAL LETTERS YOUR NAME, 
FIRST NAME AND COMPLETE ADDRESS  OF YOUR INSTITUTION. 
  THIS INFORMATION WILL APPEAR ON THE PROCEEDINGS

Mr      Ms      Name   .................................................. 
                First Name   ............................................
Professional Status : ...................................................
Date of birth : ..................
Experimentalist          Theorist       Observer    
Field of interest .......................................................
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Collaboration ...........................................................
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INSTITUTION ADDRESS 
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Phone :  ...........................  Fax :  .............................
E-mail : .................................................................

MAILING ADDRESS  (If different from institution address)
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Phone :  ...........................  Fax :  .............................
E-mail : .................................................................


HOME ADDRESS
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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 161 Euros) 
                Yes             No                   
to share a double room, please specify : 
                Smoker          Non-smoker   

What will be the approximate time of your arrival on Saturday, March 16 :
by train ....................       by car  ..........................            
by plane  in  Geneva .........................

Will you use the conference bus :  
-  On Sat. March 16,  from Geneva to Les Arcs:        No      Yes             
-  On Sat. March 23,  from Les Arcs to Geneva:        No      Yes             

DATE  :

SIGNATURE :