2006 Workshop on Algebraic Geometry and Physics Gerbes, Groupoids, and Quantum Field Theory Erwin Schroedinger Institut, Vienna, May 9-13, 2006 PRE-REGISTRATION FORM NAME: DATE OF BIRTH: POSITION: AFFILIATION: E-MAIL ADDRESS: POSTAL ADDRESS: TELEPHONE: FAX: ARRIVAL DAY (tentative date): DEPARTURE DAY (tentative date): Do you wish to present a contribution? (please erase as necessary) YES NO Title of your proposed contribution (please enclose a short abstract):): To be completed and sent by February 5th, 2006 to bruzzo@sissa.it