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: