DEADLINE FOR APPLICATION :
EW / QCD : January 31st, 2017
VHEPU / Gravitation: February 28th, 2017
(hotel reservation is made from this application form)

* fields are mandatory


Moriond Session: * 
Gender: * 
Family Name: * 
First Name: * 
E-mail: *
Professional Status: 
CNRS employee? 
(french institutions only) 
Is this your first attendance? 
Are you: 
Field of interest:
Collaboration: 
Participation: 


1. Home Institution

Institution Name: *
Street/Bldg: *
City: *
Postal code: *
Country: *
Your Phone: 
Portable Phone: 


2. Hotel Reservation
(reminder: hotel reservation is made exclusively by the conference secretariat)

Date of birth:  Place of birth:  Nationality: 

Will you be accompanied : 

> by your spouse/partner?

> by your children?

Twin room to be shared with: 

If you wish to have a single room, please mention it  
if Yes, please tick here to accept the 175 Euros supplement   

Please note that due to the limited number of single rooms available, when requested they will be attributed in priority to senior participants. A waiting list will be created and the remaining ones will be given the week before the conference by order of registration. 

3. Arrival / Departure

Will you use the conference bus:
from Geneva airport to La Thuile? 
from La Thuile to Geneva airport? 


4. Permanent address for proceedings shipping (after september)
(if different from above)

Street/Bldg: 
City: 
Postal code: 
Country: