TO BE FILLED AND RETURNED BY EMAIL TO THE ADDRESS bruzzo@sissa.it

WORKSHOP ON DEFORMATION THEORY
Trieste, January 19-23, 2004

REGISTRATION and  ACCOMMODATION FORM

NAME:

DATE OF BIRTH:

POSITION:

AFFILIATION:

E-MAIL ADDRESS:

POSTAL ADDRESS:

ARRIVAL DATE:

DEPARTURE DATE:

(notice that the standard arrival and departure days are January 18 and 24)

TELEPHONE:

FAX:

Do you wish to give a talk? (please erase as necessary)  YES NO

Title of your proposed talk:

Do you apply for financial support? (please erase as necessary)  YES NO

Please write here any possible special request (e.g., that you are coming with
an accompanying person,...)