Registration Form

I will participate of the Lishep

Session B
Session C

I will participate as a:

Speaker of Session B
Speaker of Session C
Other of Session B
Other of Session C

Do you intend to present a poster?

Yes
No

PERSONAL INFORMATION

Title If choose "other", fill the filed below.
Other
Last Name
First Name
CPF or Passport Number
E-mail

Physicist Computer Scientist Electronic Engineer Others

HOME INSTITUTE

Institution
Address
Country
State
City
ZIP Code
Phone
Country code + area code + number
5521 12345678
Fax
Additional Information
(questions, comments, etc)

PAYMENT

The registration fee covers:
     Conference attendance
     Conference material
     Conference tour
     Banquet

Payment of Registration Fee:

check this box to request the registration fee exemption
      (justify on the Additional Information box)
Cash upon arrival (US$ 400.00) (NO TRAVELLER CHECKS)
Direct deposit to our account (US$ 350.00) (after February 28th: US$ 400.00)
      Make a deposit to the following account and FAX a copy of the deposit receipt
      to the School Secretariat.

Wire Transfer To:
     Citibank N A - New York
     Swift Code: CITIBRBR
     ABA: 021000089
     DDA: 36125649

To Credit:
     Citibank/Rio de Janeiro/Brasil
     Rua da Assembléia 100
     Swift Code: CITIBRSPRJO

In Favor of:
     ASSOCIAÇÃO INTERNACIONAL DOS AMIGOS DA FÍSICA EXP DE ALTAS ENERGIAS
     C/C 75001586

Secretariat
      FAX: 55-21-25877454

HOTEL RESERVATION!

Please for Section C contact the hotel at http://www.hotelpierre.com.br/newsite/en/
or email to vendas@hotelpierre.com.br (with copy to lishep@uerj.br).

For session B please go to the page http://www.grahnoperator.com.br/events/lishep2006/

Thank you.


     

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