Registration Form

I plan to attend Nijmegen99


Name/title        :     
Sex (M/F)    : M   F   Nationality:   Birthdate: 


institute         :
street&nr, or POB :
Postal code/city  :
Country           :
telephone         :
fax               :
e-mail            :


Present professional activity 



  Ph.D. student 
  Postdoc 
  senior 

 A Ph.D. student should arrange for a reference letter of a senior physicist
 (to be sent directly to the secretariat address below)
 Postdocs and senior physicists interested should give a few key publications:








My participation depends on the availability of

 grant for fee 
 grant for travel 

Please add any comments:






 
Please return these forms directly through automated email:

 




If you can't reply from WWW, you may send an email with the requested 
information to the secretariat or print out this form and send it by fax



nijmegen99@nat.vu.nl




Secretariat Nijmegen99


Department of Physics and Astronomy,


VU, De Boelelaan 1081


NL-1081 HV Amsterdam, the Netherlands


Tel:   +31 20 444 7863
Fax:   +31 20 444 7899