SPIN-Praha-2012

ADVANCED STUDIES INSTITUTE

SYMMETRIES AND SPIN

(SPIN-Praha-2012)

Prague, July 1 - 8, 2012

Registration Form

Please fill in this form to register to Spin-Praha-2012. We also accept e-mail with the same information, but electronic submission of this web form is strongly preferred.

Deadline is June 10, 2012

	Prof. Dr. Mr. Ms. or Other:
Family name:
Name(s):
Institution (full name):
Home Institute address:
Phone (office):
FAX:
E-mail:

I am planing to give a talk:
Preliminary title:

Preliminary arrival date:
Preliminary departure date:
I am planing to reach Prague	by plane, flight N
	by train, N
	by car

Visa Information

If you need the visa for Czech Republic, please, specify


Date, month and year of birth:
Sex:
Citizenship:
Passport number:
Date, month and year of issue:
Date, month and year of expiration:
Place of applying for the visa:

(country and city in which the Czech Consulate is available)

Accompanying Person(s)

Name(s):

(children under 16, if any, name and year of birth)

Housing Reservation

I take care of the accommodation by myself
I will use the service of Organizing Committee and book

- Rezidence Dlouha 17, (***) standard !!! Fully booked already !!!

- Charles University Guest House

Double bed studio

car parking

- Charles University Hostel

Double room, single occupancy

Double room, double occupancy
I will share room with:

accommodation and housing information

I would like to draw attention of the Local Organizing Committee to the following requirements and/or comments:

Comments:

Double bed studio
car parking

Double room, single occupancy
Double room, double occupancy