XVth Rencontres de Blois

PHYSICAL COSMOLOGY
New Results in Cosmology
and the Coherence of the Standard Model

Château de Blois (France), 15th - 20th June 2003

Conference Registration And Hotel Reservation Form

deadline May 15th, 2003

(to send an abstract, use the contribution form)

Registration

(Fields followed by "*" have to be filled)

You

Mr Ms
Family name *

 First name*

Date of birth

Professional status

Professional interests

Your Institute

Address*

Country*

Your email * Your phone Your fax

Your mailing address up to the conference, if different from above

Address

Country

Your email Your phone Your fax

Hotel Reservation

I will be accompanied by persons

named

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 30 euros Single 35 to 55 euros Single 94 euros
Double 18 to 28 euros Double 62 euros
I will manage myself my hotel accommodation

For any comment or other informations


What will be the approximate time of your arrival on June 15th:
by train ? by car ? by air ?

Please do not wait until the last minute to reserve accommodation; the number of rooms at our disposal is limited!

If for some reason you cannot register electronically (preferred option)

use the paper registration form and send the form

by fax or e-mail to:

Ms Laurence Moutié
Rencontres de Blois
B.P. 33
F-91192 Gif sur Yvette
France
Tel : 33 (0)1 69 29 05 50
Fax : 33 (0)1 69 28 86 59
Email: Laurence.Moutie@th.u-psud.fr

But if possible send it electronically by pressing this button:

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