Registration Form

Registration Form

XXXVth RENCONTRES DE MORIOND
Energy densities in the Universe
January 22-29, 2000 , Les Arcs, Savoie, France

Please send this registration form to :
Ms Claire Wrzesinski
Rencontres de Moriond BP 33,
F-91192 GIF SUR YVETTE CEDEX , France
Phone : 33 (0)1 69 29 05 50 Fax : 33 (0)1 69 28 86 59
(or by E-mail to moriond@lal.in2p3.fr)

DEADLINE FOR REGISTRATION : DECEMBER 1, 1999
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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Phone :  .......................................

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 1 050 FF) 
                Yes             No                   
to share a double room, please specify : 
                Smoker          Non-smoker   

What will be the approximate time of your arrival on Saturday, January 22 :
by train ....................       by car  ..........................       
by plane  in  Geneva .........................

Will you use the conference bus :  
-  On Sat. January 22,  from Geneva to Les Arcs:        No      Yes            
-  On Sat. January 29,  from Les Arcs to Geneva:        No      Yes            

DATE  :

SIGNATURE :