Registration/hotel reservation form

24th Rencontres de Blois

Particle Physics and Cosmology

Blois, France, May 27 - June 1, 2012

Conference Registration And Hotel Reservation Form

deadline April 30th, 2012

if you cancel a hotel reservation, please do so as soon as possible, and in any case before May 1st, 2012, otherwise the hotels will retain the deposit that the conference will have paid in your place.

Please make sure that your name, the address of your institute and your email are given correctly on this form; this information will appear in the proceedings, and we must have a reliable way of conctacting you. Please enter both emails as requested on the form (current and one up to date of conference, even if identical; you will get an error message if one of them is left blank!).
Please do not register more than once. When you register electronically (see below), you should wait until the system responds with a confirmation that your form has been successfully sent. Depending on the internet traffic, this may take a few tens of seconds; after confirmation you may shut down your browser. Only if you are told that the form could not be sent should you resubmit (probably somewhat later!).

Registration

You

Mr Ms

Professional status

Family name First name

Date of birth

Professional interests

I

I plan to submit one or more contributions for a poster session

with the following titles:

I plan to submit oral contributions to a submitted papers session (maybe parallel or plenary)

with the following titles:

Your Institute

Address line 1

Address line 2

Address line 3

Address line 4

Address line 5

Country

Your email obligatory; please enter it again in blue box below even if same !! Your phone Your fax

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

Address line 1

Address line 2

Address line 3

Address line 4

Address line 5

Country

Your email up to the conference: obligatory even if same as above Your phone Your fax

Vegan meals required
yes no

Vegetarian meals required
(fish accepted)
yes no

Hotel Reservation

I will be accompanied by persons

named

If you have made your own hotel reservation, click here please=>
type the name of the hotel,
and ignore the rest of this form

Otherwise, if you wish the reservation to be made by the conference, and you are accompanied, please give the following details

I would like the conference to reserve for me:
single room/s double room/s

in a one star two star hotel

or if not accompanied, please give the following details:

I would like the conference to reserve for me:
one star two star hotel

I would like a single room

I accept to share a double room
with a non-smoker or
with a smoker (click whichever is appropriate)

Very approximate price range per night (breakfast is included; all rooms have a shower or a bath)

1 star hotel 2 star hotel 3 star hotel (Holiday Inn Garden)

Single room:
about 44 euros
Single room:
about 46 to 90 euros
Single room:
about 120 euro

Shared double room:
about 28 euros per person
Shared double room:
about 29 to 49 euros per person
Shared double room:
about 65 euros per person

I will arrive on at approximately

I will leave on at approximately

by train by car by air

Please do not wait until the last minute to reserve accommodation; at this time of the year, Blois can be very crowded!

If for some reason on line registration does not work in your case, you may print and fill in this form manually, and send it to:
Ms Hady SCHENTEN Rencontres de Blois BP 33, F-91192 Gif sur Yvette France Tel : 33 (0)1 69 28 51 35 Fax : 33 (0)1 69288659 email: hady.schenten@orange.fr

Send this form electronically by pressing this button:
Please wait for electronic confirmation before leaving your browser. This may take a few tens of seconds if internet traffic is heavy. Do not resubmit unless you are informed that the form could not be sent. You should also receive a copy of the form by email a little later. Thank you.

I plan to submit one or more contributions for a poster session
with the following titles:

Address line 1
Address line 2
Address line 3
Address line 4
Address line 5

1 star hotel	2 star hotel	3 star hotel (Holiday Inn Garden)
Single room: about 44 euros	Single room: about 46 to 90 euros	Single room: about 120 euro
Shared double room: about 28 euros per person	Shared double room: about 29 to 49 euros per person	Shared double room: about 65 euros per person

I will arrive on		at approximately
I will leave on		at approximately