ISSRNS’2000 REGISTRATION FORM

ISSRNS’2000 REGISTRATION FORM
(please return in a letter or by e-mail as an attachment by April 30^th , 2000)

I will attend the ISSRNS’2000 with without accompanying persons

Title_______ First Name(s):__________________Family Name____________________ Male/ Female
AFFILIATION____________________________________________________________________________________
________________________________________________________________________________________________
MAILING ADDRESS______________________________________________________________________________
_________________________________________________________________________________________________
Phone____________________ Fax_________________________E-mail______________________________________

Arrival date (train /airplane /car ) ________________ Departure date_________________________
I am interested in travelling from Cracow to Jaszowiec by the school bus on Sunday June 11^th.

PAYMENT METHOD (Check one)

Eurocheck / Money Transfer / Cash upon Arrival (in PLN)
Please charge my
(Visa / Eurocard / MasterCard ) Credit Card # ____________________________Exp. Date ______________

Date________________ Signature___________________________________

Payment should be made to:
Polskie Towarzystwo Promieniowania Synchrotronowego, ul. Reymonta 4, 30-059 Kraków
Bank PeKaO S.A. O/Kraków, account # 12401431-7023022-2700-401112
S.W.I.F.T. # PKOP PL PW