Registration Form
IVth RENCONTRES DU VIETNAM

PHYSICS AT EXTREME ENERGIES
Physics and Astrophysics


Hanoi, Vietnam July 19 -25, 2000

Please send this registration form to :
Ms Claude Barthelemy
Rencontres du Vietnam
LPT - Batiment 210
F-91405 Orsay cedex , France
Phone : 33 (0)1 69 15 82 16 Fax: 33 (0)1 69 15 82 87
(or by E-mail to claude.barthelemy@th.u-psud.fr)

Please return this registration form as soon as possible and before April 30th, 2000 
                         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   ............................................

Experimentalist          Theorist       Observer    
Field of interest .......................................................
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Collaboration ...........................................................
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INSTITUTION ADDRESS 
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Phone :  ...........................  Fax :  .............................
E-mail : .................................................................

HOME ADDRESS
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Phone :  ...........................  

HOTEL RESERVATION
Will you be accompanied  :      -  By your spouse   :   
Name & First Name ................................................
                                -  By your children :
First Name  .................................   Age    ...............
First Name  .................................   Age    ...............
First Name  .................................   Age    ...............


If you wish to have a  single room, please mention it 
                Yes             No                   
to share a double room, please specify : 
                Smoker          Non-smoker   


I am interested in participating to the following post-conference tours:
             Tour 1   Yes  No
             Tour 2   Yes  No
             Tour 3   Yes  No


DATE  :

SIGNATURE :