Registration Form

XVth RENCONTRES DE BLOIS
PHYSICAL COSMOLOGY
15th - 20th June 2003, Château de Blois, France

Please send this registration form to :
Rencontres de Moriond, BP 33
F-91192 GIF SUR YVETTE CEDEX , France
Phone : (33 1) 69 29 05 50 Fax : (33 1) 69 28 86 59
(or by E-mail to Laurence.Moutie@th.u-psud.fr)

DEADLINE FOR REGISTRATION : April 30, 2003
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 : ..................
Field of interest .......................................................
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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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I Will be accompanied  :   - ................................................
(Name & First Name)        - ................................................
                           - ...............................................
                           - ................................................



I wish to reserve accomodation as follows:
price range per person / per night (breakfast included)

1 STAR HOTEL           
Only single 32 to 38 euros

2 STAR HOTEL            
single 42 to 53 euros
double to be shared with another person 26 to 38 euros
 
3 STAR HOTEL
single 76 to 84 euros
double to be shared with another person 48 to 55 euros


I accept to share a double room

         with a smoker             with a non smoker

DATE  :

SIGNATURE :