RENCONTRES DE MORIOND

QCD and High Energy Hadronic Interactions

Mr or Mrs :		QCD session 18/25 March 06
Family name :
First name :
Date of birth (dd/mm/yyyy):
Nationality :
Professional status :
Is this your first attendance :	Yes No
Are you :
Fields of interest :
Collaboration :

Home institution address :
Name :
Street/PObox/etc :
City :
Postal code :
Country :
Phone :
Fax :
Email :

Institution mailing address (if different from institution address) :
Name :
Street/PObox/etc :
City :
Postal code :
Country :
Phone :
Fax :
E-mail :

Which institution should appear in all the conference documents ?

Will you be accompanied ?
by spouse/husband ? yes no	Name and first name :
By your children ? yes no	First name First name First name	birth date (dd/mm/yyyy) birth date birth date

If you wish to have a single room, please mention it (suppl. of 140 euros)
To share a room, please specify :

What will be your approximate time of arrival on Saturday March 18th ?		by ?

Will you use the conference bus :
on saturday, March 18th, from Geneva airport to La Thuile at 13h30 ?		n° of seats :
on saturday, March 25th, from La Thuile to Geneva airport at 12h30 ?		n° of seats :