36th Liège International Astrophysical Colloquium:

REGISTRATION FORM

Please fill-out this form
First Name:
Last Name:
Title:
Initials:
Complete mailing address:
Phone:
Fax:
E-Mail:
I shall be accompanied by Person(s)
I wish to present the following contribution:
15 min. talk
poster
Title:
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 :
  VISA
  MASTERCARD
Card number Expiration date Card holder

  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