XIVth RENCONTRES DE BLOIS
16th - 22nd June 2002

MATTER-ANTIMATTER ASYMMETRY
Château de Blois (France)



REGISTRATION AND HOTEL RESERVATION FORM

DEADLINE FOR REGISTRATION : May 31th, 2002

Please indicate clearly on this form your first and last names, and the complete address of your institution, since this information will appear in the proceedings.

To register when the fields are filled please press the submit button at the bottom

or use the pdf registration form and send the form

by fax or e-mail to:
Mr. Christophe Node-Langlois
  Rencontres de Blois
  BP 33
  F-91192 Gif sur Yvette cedex
  Tel : 33 (0)1 69 29 05 50
  Fax: 33 (0)1 69 28 86 59
  e-mail:chrisnl@lal.in2p3.fr

Fields followed by "*" have to be filled

Identity

FAMILY NAME * First Name *


Date of birth *

dd mm yyyy


Professional Informations


Professionnel statut

Institute Address

Intitute Name *


Address 1


Address 2


Post Code *

City *

Country *


E-mail *

 Phone Fax


Mailing address

( if different from institution address )


Hotel Booking Informations

 I will be accompanied by persons

Family Name   First name

( Of the persons you will be accompanied with)


I to share my room with an other participant

Family Name   First name

( of participant you would prefer to share with )


I want please a room.

I wish to reserve accommodation as follows *

1 STAR HOTEL 2 STAR HOTEL 3 STAR HOTEL
Only single 32 to 38 euros Single 42 to 53 euros Single 76 to 84 euros
Double 26 to 38 euros Double 48 to 55 euros
I will manage myself my hotel accommodation

For any comment or other informations


Arrival Informations

I will arrive in Blois on
at approximate time by


I acknowledge that I have asked the conference to pay a hotel deposit of 100 Euros

in my place in order to guarantee my hotel reservation.

I will undertake to reimburse the conference for this sum if I cancel my resevation after May 20th, 2002.

To register when the fields are filled please press the submit button.

You should receive soon an e-mail to confirm your inscription.