XIVth  SYMPOSIUM ON ATOMIC, CLUSTER AND SURFACE PHYSICS

SASP 2004

February 1-6, 2004

Hotel Planibel, La Thuile, ITALY

 

REGISTRATION FORM

 

Family Name : ____________________(Prof/Dr/Mr/Mrs/Miss)  First name(s): _________________

Affiliation :     ________________________________________________

Mailing Address :       __________________________________________

                                   __________________________________________

                                   __________________________________________

Telephone :     ____________________       FAX : ___________________

E-mail address :         __________________________________________

I will be accompanied by my spouse : _______________ and ___________ other persons.

 

Registration Fee, and Accommodation and Meals

 

NOTE : add EURO 50 for payment after 15 November 2003

 

Double room (single occupancy)       EURO             900      (x __ persons)            EURO ______

Double room (per person)*                EURO             650      (x __ persons)            EURO  ______

Triple room (per person)* (student)   EURO             550      (x __ persons)            EURO  ______

 

Accompanying persons                      EURO             550      (x __ persons)            EURO  ______

 

* Indicate name of roommate(s) ________________________________

 

                                               TOTAL AMOUNT ENCLOSED                EURO    ___________

 

 

Title(s) and authors of contribution(s):

 

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Payment of TOTAL AMOUNT ENCLOSED (in EURO) should be made via cheque or bank transfer (a copy of payment advice must be attached) to :

 

Dipartimento di Chimica - Universitΰ di Perugia

BANCA DELL' UMBRIA 1462 S.p.A., Agenzia N. 6

06100 – PERUGIA

Italy

(Bank coordinates: ABI 06235, CAB 03198)

Account number:         901-17142

SWIFT code:              CRPGIT3P

IBAN code:    IT39V0623503198000000017142

 

with indication: SASP 2004 - Participant name : ..............................................

 

Please, be sure that the indication SASP 2004 and your name are included.

 

 

Please return the completed registration form, together with the payment in EURO (a copy of payment advice must be attached) and the abstract(s) by 15 November 2003 to :

 

Prof. P. Casavecchia

SASP 2004

Dipartimento di Chimica

Universitΰ di Perugia

Via Elce di Sotto, 8

06123 PERUGIA

Italy

Phone: (+39) 075 585 5514

Fax: (+39) 075 585 5606

E-Mail: piero@dyn.unipg.it

 

Further Information :

Further information may be obtained from the conference Web site :

http://www.chm.unipg.it/chimgen/mb/cong/SASP2004.html

or by writing to Prof. P. Casavecchia at the above address.