| First name |
|
| Second name |
|
| Affiliation |
|
| e-mail address |
|
| Phone |
|
| Date of arrival |
|
None of these, I will arrive on |
| Date of departure |
|
None of these, I will leave on |
| Do you wish to participate in the workshop dinner
? Yes No |
| Please indicate if you have any special food
requirements
|
| |