This form must be sent by FAX to the IAC Chairman, at +39-6-94032900
First Name: ________________________________________ Middle Name: ________________________________________ Last Name: ________________________________________ Institute: ________________________________________ Address: ________________________________________ City/Country:________________________________________ Phone: ________________________________________ Fax: ________________________________________ E-Mail: ________________________________________
Requested level of support (DO NOT TICK MORE THAN ONE): 1)Travel [_]Yes [_]No if yes, indicate amount(US$)..........
2)Lodging [_]Yes [_]No:
3)Registration fees waiver [_]Yes [_]No:
I have asked ............. for a letter of reference, which
will be sent under separate cover to the IAC Chairman:
Franco L. Fabbri - IAC Chairman
Laboratori Nazionali di Frascati
Via E. Fermi 40, 00044 Frascati, Roma
Please write a short C.V. and the reason for your request: _________________________________________________________________
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If you have not requested travel support
let us know the following:
Arrival: _______/________/1998
[_]by plane [_]by train [_]by car [_]Don't know yet
Departure: _______/________/1998
[_]by plane [_]by train [_]by car [_]Don't know yet
Hotel Reservation (If you have not requested lodging support):
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
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:_________________________________________
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