Interdisciplinary Conference: Einstein meets Magritte
Participation forms
_____________________________________________________________________
REGISTRATION FORM
To return to:
Congress Office Orga-Med, Ms Ria Maes
Essenestraat 77, B-1740 Ternat, BELGIUM
Fax 32 2 582 55 15,
e-mail: einmag@vub.ac.be
IDENTIFICATION
Name: First name:
Affiliation:
Institute:
Department:
Street & number:
Code and City:
Country:
Tel.:
Fax
e-mail:
Accompanying person(s), Name(s):
I want to receive further correpondence
O by ordinary mail O by e-mail
Send me an official letter of invitation 0 yes 0 no
REGISTRATION DETAILS
A. Main programme
0 Full registration before 15 April 1995 13,000 BEF
0 Full registration after 15 April 1995 15,000 BEF
0 On-site registration 17,000 BEF
0 Single-day registration 3,000 BEF
O Monday 29 May 1995
O Tuesday 30 May 1995
O Wednesday 31 May 1995
O Thursday 1 June 1995
O Friday 2 June 1995
O Saturday 3 June 1995
Subtotal A ....... BEF
B. Accompanying persons programme
(see programme details)
0 Day-tour in Brussels, 29 May 2,520 BEF
0 Day-tour to Antwerp, 30 May 3,410 BEF
0 Day-tour to Lessive, 31 May 2,660 BEF
0 Day-tour to Bruges, 1 June 2,730 BEF
0 Day-tour to Spa, 2 June 1,890 BEF
Subtotal B ....... BEF
C. Banquet
0 I will attend with ... persons at 1,750 BEF pp
Subtotal C ....... BEF
D. Lunches at 350 BEF per lunch (please tick your choice in 0 )
0 Monday 29 May 1995
0 Tuesday 30 May 1995
0 Wednesday 31 May 1995
0 Thursday 1 June 1995
0 Friday 2 June 1995
0 Saturday 3 June 1995
Subtotal D ....... BEF
_______________________
TOTAL ....... BEF
PAYMENT METHOD
Please indicate method of payment
0 Bank to bank transfer to ASLK, Agency VUB Oefenplein, Pleinlaan 2,
B-1050 Brussels, Belgium, Account number: 001-0686455-62
Please mention your name,'Einstein meets Magritte' and 'F29892'.
0 Banker's draft
O Crossed and numbered Eurocheque to a maximum of BEF 7,000 per
cheque
Signature: Date:
_____________________________________________________________________
ABSTRACT SUBMISSION FORM
To return to:
'Einstein meets Magritte', Theoretical Physics, TENA,
University of Brussels, Pleinlaan 2,
B-1050 Brussels, Belgium
Deadline for abstracts: April, 15, 1995
Name: First name:
Affiliation:
Institute:
Department:
Street & number:
Code and City:
Country:
Tel.:
Fax :
e-mail:
I want to receive further correpondence
0 by ordinary mail 0 by e-mail
I want my abstract to be considered for:
0 talk 0 poster
Typing instructions for the abstract:
- The abstracts should be written in English.
- Authors should use a maximum of one single page for their abstract.
- The header of the page should contain the title, the author with surname
first, followed by initials, and the institution identified with full
address.
- Use a laser printer or an electric typewriter with carbon ribbon.
Please read carefully the guidelines.
_______________________________________________________________________
HOTEL RESERVATION FORM
To return before April 15, 1995, only by ordinary mail or fax, to the
Conference Secretariat:
Ms Ria Maes, Orga-Med, Congress-Office,
Essenestraat 77, B-1740 Ternat, Belgium
Tel ca.32 (0)2 582 08 52
Fax ca.32 (0)2 582 55 15
IDENTIFICATION PART
Surame & given name:
.....................................................................
Address:
.....................................................................
Post code/City:
..........................................Country:..................
Tel.: ...................... Fax:......................
RESERVATION DETAILS
Arrival date: ...... May/June 95
Departure date: ....... May/June 95
Number of nights: .........
Please tick choice of hotel and room:
(second choice: ......................)
O Single O Double
O Hilton Hotel Brussels BEF 6,200 BEF 7,000
O Hotel Metropole BEF 4,500 BEF 6,000
O Holiday Inn BEF 4,250 BEF 4,400
O Ibis BEF 3,975 BEF4,300
O Lower Budget hotels BEF 2,000-2,800 BEF2,400-3,250
(Breakfast and taxes are included in the above mentioned prices).
(Remark that all invited speakers will stay in Hotel Metropole)
O 'Economical solutions':
O I shall use my own tent O I would like to rent a tent
O I am interested in student accommodation (limited number,
first-come-first-served basis)
CONDITIONS FOR HOTEL RESERVATIONS
No deposit is requested. Written confirmation after receipt of
credit-card data as guarantee. Payment will be made in the hotel. For
cancellations more than 3 weeks before arrival, BEF500 will be
charged. Three weeks before arrival : one night will be charged +
BEF500. No show: all reserved nights will be charged + 500
Cardnumber: ......................
Exp.date: ........................
Company:
O Eurocard/Master O Visa
O American Express O Diners
Signature: ..................... Date: ........................
From Sunday 28 May to Saturday 3 June 1995, free camping will be
possible on the campus of the University. The necessary facilities
will be available. Those participants who wish to camp need to
register via this form as well. A limited number of places at the
student accommodation sites will be available.