Physics in Collision '98 WWW Registration Form:
Due before April 3rd 1998

Please fill in this application form and send it to +39-6-94032900.

First Name:  ________________________________________

Middle Name: ________________________________________

Last Name:   ________________________________________

Institute:   ________________________________________

Address:     ________________________________________

Country:     ________________________________________

Phone:       ________________________________________

Fax:         ________________________________________

E-Mail:      ________________________________________

Arrival:     _______/________/1998

             [_]by plane [_]by train [_]by car [_]Don't know yet

Departure:   _______/________/1998

             [_]by plane [_]by train [_]by car [_]Don't know yet

Are you participating in the post-conference
Gran Sasso visit?: [_]Yes [_]No

Hotel Reservation:

Are you making your own hotel reservation?: [_]Yes [_]No

If yes, let us know the hotel you booked:

Do you want us to book for you at Villa Campitelli
under Physics in Collision arrangement? :[_]Yes [_]No

Room: [_] Single [_]Double 

from: _______/________/1998    to: _______/________/1998

Accompanying person:  [_]none; [_]1; [_]2; [_]3; [_]more 

First Name:    ________________ ________________ ________________

Middle Name:   ________________ ________________ ________________

Last Name:     ________________ ________________ ________________

adults/children:     [_] adult       [_] adult       [_] adult
                     [_] child       [_] child       [_] child

Participation in social events:

Lunch at Laboratories [_]Yes [_]No

Get-together at winery [_]Yes [_]No

Social dinner [_]Yes [_]No

Post-Conference Gran Sasso Laboratory visit [_]Yes [_]No

Any special requirement:_________________________________________

_________________________________________________________________

_________________________________________________________________