REGISTRATION FORM

Please fill out the form below and send it to donata@oapa.astropa.unipa.it at your earliest convenience, but no later than July 16, 2004,. Please do not include multiple people on the same form. Every attendee must submit a registration form.

If you have any questions, please feel free to send an e-mail to donata@oapa.astropa.unipa.it

First Name / Last Name: ______________________________________

Affiliation: _________________________________________________

Email:________________________________________________________

Mailing Address:______________________________________________

Country:______________________________________________________

Phone:________________________________________________________

Fax:__________________________________________________________

Title of Contributed Talk (if any):___________________________
______________________________________________________________

HOTEL RESERVATION
Date of Arrival:_____________ Date of Departure:_______________

Single Room * + breakfast (113 Euro/night):____________________

Double Room * + breakfast (124 Euro/night):____________________
* Note: Single rooms = Double Rooms, single use

Accompanying Person:___________________________________________

Special Requirements:__________________________________________

Credit Card Information:
Card Holder:__________________________________________

Type of CC: VISA___ MASTERCARD___ AMERICAN EXPRESS___

CC Number:______________________ Expiration Date:_______________

Registration Fee (after July 16): 50 Euro____