===================================================
 
XXXXth RENCONTRES DE MORIOND
QCD AND HIGH ENERGY HADRONIC INTERACTIONS
La Thuile, Aosta valley, Italy
March 12th - March 19th, 2005

REGISTRATION FORM

Important remark : Talk requests should NOT be made through this administrative form, but sent by email to a member of the program committee with a copy to Etienne Augé, as described in section III.3 of the Bulletin. 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 Saturday March, 12th : by train ....... by car ...... by plane ...... Will you use the conference bus : On Saturday March 12th from Geneva to La Thuile at 13 h 30 : No Yes Number of seats ...... On Saturday March 19th from La Thuile to Geneva at 12 h 30 : No Yes Number of seats ...... Date : ............................ Signature : Please return this registration form as soon as possible to : Mrs Elizabeth Hautefeuille Rencontres de Moriond, BP 33 104, avenue du Général Leclerc F-91192 GIF SUR YVETTE CEDEX FRANCE Tel : 33.(0)1 69 29 05 50 Fax : 33.(0)1 69 28 86 59 E-mail : elizabeth.hautefeuille@th.u-psud.fr DEADLINE FOR REGISTRATION : JANUARY 31ST, 2005 NO HOTEL RESERVATION WILL BE MADE WITHOUT THIS REGISTRATION FORM ==================================================================