REGISTRATION FORM

Title First Name Last Name

Affiliation Address

City Zip Country

E-Mail

Phone

Fax

The red requests are mandatory!

Contributions

ABSTRACTS - Deadline April 30th, 2006

Do you want to present a contribution? YES NO. If "Yes", send it to the channeling2006@lnf.infn.it .

In the menu item"Proceedings" you will find information about submition.

Fees

I will pay cash at the registration desk YES NO

I have sent the amount of Euros as on (date)

through the bank(name) Fee Payment Order Number

 

Accommodation

Conference's Hotel

Other Hotel

Arrival Date

Departure Date

 

Participants are kindly requested to book hotels by themselves and for logistic reasons inform us about

Social Event

Social Dinner YES NO N. of companions
Excursion YES NO N. of companions
 

Limited funding is available for attending the conference. Preference will be given to young scientists. Financial support can be requested for one of the following options: Travel, Lodging, Registration fees.
Specify below why you need a financial support.

Any other information or special requirements:

    

02/8/2006 Donatella Pierluigi