FFAG
2006
       
Semi-Annual International
2006 FFAG Workshop

Being Held At:
Danford's On The Sound, Port Jefferson, NY

 May 15 - 19, 2006

     
 

FFAG-2006 Workshop Registration Form
 

Items in RED are mandatory fields and must be filled in.
 Preferred Title:   Prof.     Dr.     Mr.     Mrs.     Ms.   

 

  Family Name
  First Name
M.I
 
   Institution for Name Tag ( Institute/Laboratory/University/Company Name )
 
Street Address

  City 
State/Province/Pref.
Enter "none" if not applicable		 Postal Code

Country
Required if "Other" Country Selected 		  
Telephone Information: ( include country and/or area codes )
 
 
   Work Number
  Home Number
  Fax Number
   Enter a valid email address to receive a written confirmation.
   Email Address
 
   Name of person to contact in an emergency
  Emergency Number
 

Hotel and Travel Information:

 
Date of Arrival Time of Arrival Airport of Arrival
     
Date of Departure Time of Departure Airport of Departure
   
How will you arrive at the workshop hotel? Accommodations
   
If you are requesting a Limousine, please provide your Airline and Flight information here:
Breakfast is not included in the room fee.
If you wish to have breakfast vouchers arranged by the Workshop Secretary, please indicate the number of breakfast vouchers you are requesting at $15.00 per person per day.
Check this box if you are a BNL Employee:
Names of Accompanying Persons:
( not participating in the Scientific Program )
 Please type the name of each person ( separate each name with a comma )
 
Presentations:
Will you be preparing a presentation? Yes   No  
Presentation 1 Title and Topic:

 
Presentation 2 Title and Topic:

 
Welcome Reception:

Are you planning to attend the Welcome Reception?   Yes   No  

Please visit the Welcome Reception link for details.
Buffet Dinner:

Wednesday, May 17, 2006 at Danford's On The Sound.

Are you planning to attend the Buffet Dinner?     Yes   No  

Please visit the Buffet Dinner link for details.

Registration Fee: (covers the Welcome Reception and Coffee Breaks during the Workshop)
Registration Amount - - - - - - - - - -

This is due at check-in - cash (US$)

$180.00    

  NOTE: Any changes after Final Submit must be made through the Workshop Secretary

BNL


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ALL RIGHTS RESERVED

 


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