Registration for Low x Workshop and Accommodation

Contact Information:

1) Personal data:

Title*: 

First Name*: 

Last Name*: 

Institution*: 

2) Name and Institution to appear on your badge (if different from above):

Name: 

Institution: 

3) Mailing Address:

Street address*:

City*: 

State/Province (optional): 

Zip/Postal code*: 

Country*: 

Work Phone:  country code* + area code* + number*

Fax:  country code* + area code* + number*

E-mail*: 

Private/Mobile Phone (optional): 

Arrival and departure information

1) Dates (please select). Please note that we cannot assist you in finding accommodation
    outside the dates indicated below
 

I plan to arrive in Kraków		I plan to leave Kraków
on* ** select one ** Tuesday, June 26 Wednesday, June 27 Thursday, June 28 Friday, June 29 Saturday, June 30	approx. time:	on* ** select one ** Wednesday, June 27 Thursday, June 28 Friday, June 29 Saturday, June 30 Sunday, July 1 Monday, July 2	approx. time:

2) Means of transport (optional)

arrival

flight, train no:       from: 
 

departure

flight, train no:       to: 

Accommodation

For details please consult Workshop home page: http://th-www.if.uj.edu.pl/low_x/general.html#acc

I would like to stay at ( or need no accomodation assistance in Kraków )

• my first choice (prefered)*: ** select one ** I do not need assistance with accommodation in Kraków University Guesthouse Florianska 49 University Guesthouse Garbarska 7a University of Mining and Metallurgy Guesthouse Pilsudskiego 16 Student Hostel Bydgoska 19 I need financial support and wish to stay at the Institute of Nuclear Physics
• second choice: ** select one ** University Guesthouse Florianska 49 University Guesthouse Garbarska 7a University of Mining and Metallurgy Guesthouse Pilsudskiego 16 Student Hostel Bydgoska 19 I need financial support and wish to stay at the Institute of Nuclear Physics

I would like to stay in single* / double  room. If in double room, please name another
participant/accompanying persons you would like to share your room with:

If you come with accompanying persons please enter their names below:

1)
2)

Accommodation will be booked according to the arrival/departure information above.

Should your accommodation dates be different, please indicate below:

Arriving in the hotel: 

Leaving the hotel: 

Important: we can assist you with accommodation only in the period indicated in
arrival and departure information above.

Lunches

Lunches will be served in the nearby restaurant Chimera.

I would like to have lunches on the following days*:
 

Date:	How many:
Wednesday, June 27	* ** select number ** (0) no lunches 1 2 3
Thursday, June 28	* ** select number ** (0) no lunches 1 2 3
Friday, June 29	* ** select number ** (0) no lunches 1 2 3
Saturday, June 30	* ** select number ** (0) no lunches 1 2 3

Conference Dinner

Conference Dinner will be on Thursday, June 28 and is included in the conference fee.

1) I am not going to take part in the Conference Dinner*........................

2) I shall take part in the Conference Dinner (default selection).................

Cost of the conference dinner for an accompanying person will be PLN 100.

3) Number of accompanying persons taking part in the Conference Dinner*........... ** select number ** (0) no accompanying persons 1 accompanying person 2 accompanying persons 3 accompanying persons

Special needs

1) Do you need official invitation for example for visa or travel reimbursement?

2) Special dietary needs: