Angra dos Reis, RJ – Brazil / 23-25 February 2005
If you wish to participate
please cut the registration form below, fill it and send it
at your earliest convenience to (click in the email)
- lenews05@cbpf.br
by e-mail (preferred)
or by fax to:
Prof. Joćo dos Anjos
LENEWS05 Secretariat
fax ++55 21 21417400
DEADLINE FOR REGISTRATION: JANUARY 21, 2005
VERY IMPORTANT: We can accept registrations after JANUARY 21, 2005, that will be pending of existence of avaliable rooms
IMPORTANT NOTES:
We strongly recommend participation for the whole Workshop period, i.e.,
arrival on Febr. 22 (Tuesday) and departure on Febr. 25 (Friday).
Accommodation at Hotel do Frade can be extended beyond these dates are possible at same rates.
Conference Fee = US$ 100 (To be payed in US or EU cash at arrival).
No conference fee for accompanying persons. Accompanying persons pay the same rate as the participants.
___________________________ cut here _________________________________________
REGISTRATION FORM : FUTURE LOW-ENERGY NEUTRINO EXPERIMENTS 2005
(LENEWS 2005)
(*) = Required fields
PERSONAL DATA:
First name (*) =.............................
Middle name (*)=.............................
Family name (*) =............................
Sex (*) =..........................
Age =..............................
Professional status =.......................
Field of interest =.........................
Institution (*) =.......................................
Address (*) =.........
=..................................
=..................................
Fax (*) =..........................
Phone =............................
E-mail (*) ?..........
TRAVEL AND ACCOMMODATION:
Expected Arrival date (*) ....................................................
Expected Departure date (*) ..................................................
By (check one): Plane / Bus / Car (*) ......................................
Will you use the Workshop shuttle (*) ........................................
Will you be accompanied (*) ..................................................
By your spouse : First and Family name .......................................
By your children : First Name ..................................... Age ......
First Name ..................................... Age ......
First Name ..................................... Age ......
Do you wish to have a single room (*) ........................................
If you wish to share a double room, please specify: Smoker ... Non-smoker ...
Date (*) ...................... .
