HOTEL ACCOMMODATION

III Workshop on Non Equilibrium Phenomena
in
Supercooled Fluids, Glasses and Amorphous Materials
Pisa, Italy, September 22 - 27, 2002

Please return this form before June 30th, 2002

After this date room availability will be not guaranteed !

Please print:

 Dr: , Prof: , Mr: , Mrs:
Family Name

First Name

Affiliation

Address

City Zip Code

Country E-mail:

Phone Fax

Accompanied by:
Last Name , First Name

Travelling by: Plane, Train, Car

Arrival , Departure , N. of nights

Hotel 4 stars, Hotel 3 stars, Hotel 2 stars

 

Please send this form to L&B Studio
by  FAX (+39-050-540711)

or E-mail (

 )

 

Date

N.B. With reference to the italian law 675/96 please be informed that your personal data will be used by III Workshop on Non Equilibrium Phenomena in Supercooled Fluids, Glasses and Amorphous Materials within its normal institutional activity. We also inform you that your personal data will be inserted in the list of participants relative to the present event.