36
th
Liège International Astrophysical Colloquium:
REGISTRATION FORM
Please fill-out this form
First Name:
Last Name:
Title:
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I shall be accompanied by
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I wish to present the following contribution:
15 min. talk
poster
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Author(s) and affiliation(s):
The abstract should be E-Mailed separately to
astrocol@astro.ulg.ac.be
Hotels
: indicate the name of the hotel, double room, single room, arrival date, departure date and number of nights
Payment of the registration fee : 8 500 BEF (211 EUR) -
lunches and proceedings included (please notify if you wish to get a vegetarian meal)
I choose to pay :
By Credit Card :
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By a transfer of 8 500 BEF (211 EUR): to the Fortis Bank, Agence de Liège-Cointe,
Avenue de l'Observatoire, 278, B-4000 LIEGE, BELGIUM
Account Nr: 001-1514415-30 "Liège Meeting"
Please mention your name with the payment
By a check of 8 500 BEF (211 EUR): it must be in Belgian francs and addressed to
D. CARO,
Institut d'Astrophysique et de Géophysique,
Avenue de Cointe, 5
B-4000 Liége, BELGIUM.
Colloquium:
astrocol@astro.ulg.ac.be
Pages WWW:
admin.ago@uliege.be