Registration Form

XLIst RENCONTRES DE MORIOND
COSMOLOGY
March 18 - 25, 2006, La Thuile, Valle d'Aosta, Italy

Please send this registration form to :
Elizabeth Hautefeuille
Rencontres de Moriond, BP 33
104, avenue du Général Leclerc
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 elizabeth.hautefeuille@th.u-psud.fr)


DEADLINE FOR REGISTRATION : January 31, 2006
NO HOTEL RESERVATION WILL BE MADE WITHOUT THIS REGISTRATION FORM

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 Contributions). or use the contribution 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   ............................................
Date of birth : ..................
Nationality : ...........................................................
Professional Status : ...................................................
Is this your first attendance? ..........................................
Experimentalist          Theorist       Observer    
Field of interest .......................................................
.........................................................................
Collaboration ...........................................................
.........................................................................

HOME INSTITUTION ADDRESS (1)
..........................................................................
..........................................................................
..........................................................................
..........................................................................

Phone :  ...........................  Fax :  .............................
E-mail : .................................................................

INSTITUTION MAILING ADDRESS  (2) (If different from institution address)
..........................................................................
..........................................................................
..........................................................................
..........................................................................

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  .................................   Birth date    ........
First Name  .................................   Birth date    ........
First Name  .................................   Birth date    ........


If you wish to have a  single room, please mention it (suppl. of 140 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 18th :
by train ....................       by car  ..........................            
by plane  in  Geneva .........................

Will you use the conference bus :  
-  On Sat. March 18th,  from Geneva Airport to La Thuile :  No      Yes       
                        Number of seats        .....
-  On Sat. March 25th,   from La Thuile to Geneva Airport :  No      Yes       
                        Number of seats        .....

DATE  :

SIGNATURE :