REGISTRATION FORM

Energy Localization: From Small Polyatomic Molecules to Large Biomolecules

September 6-8, 2004

PLEASE RETURN BY May 31, 2004 to :    

Prof. Stavros C. Farantos
Institute of Electronic Structure and Laser 
Foundation for Research and Technology-Hellas
Iraklion 711 10, Crete, Greece

Tel:    +30-81-391813
FAX:    +30-81-391305
e-mail: farantos@iesl.forth.gr

Prof.  __  Dr.  __  Mr.  __  Mrs.  __  Ms.  __

Name:

Address:

City:

Zip code:

State/Country:

Phone:

Fax:

E-mail:

I will be accompanied by Dr./Mr./Mrs./Ms.:

I will submit a contribution for the workshop

Title:

I will arrive at Lyon on ...........................(indicate date)
and depart from Lyon on  ...........................(indicate date)

I will need accommodation for ..... person(s) as follows (please check one)
_______ single room
_______ twin  room

Requests for sppecial support/or comments: