5th Guillermo Haro Astrophysics Programme

Advanced Lectures on the Starburst-AGN Connection 

June 26-30, 2000

Registration Form

1. Basic Data

Surname: 
Name: 
Institution:  Use abbreviated form e.g. INAOE, Mexico 
E-Mail:

2. Pre-registration

If you have already sent in the abstract you can skip through this section
Address: 
Telephone:  Fax: 
Are you a Student? 
Do you wish to present a poster? 
Title: 
Author(s): 
Affiliation(s):  Use abbreviated form e.g. INAOE, Mexico 
Abstract:  Preferably in LaTex format

3. Hotel Registration

If you have already sent us your Hotel of preference, you can skip through this section

Accomodation --- choose any one of the following:

  1. Hotel Señorial
  2. Villas Arqueológicas (Club Med)
  3. UDLA
  4. I prefer to stay in Downtown Puebla

    5. (in this case you need to send an email briefing your preferences)
  5. None (I will make my own arrangements)


Click here to get the Hotel details

Second Choice (in the case your 1st choice is sold out)
Name of Hotel: 

Number of persons accompanying you: 

If you would like to share a room with another participant please provide his/her name:
 
Date of Arrival:  , 2000 
Date of Departure:  , 2000
Number of Nights: 

4. General

In order to help us give you a better service, we will appreciate you reply the following questions too:
Gender
Are you a smoker?
Are you a vegetarian?
Are you likely to attend the reception on Sunday evening?

If you have any special needs please explain it below:

Please submit the completed form before May 7, 2000.
On clicking "Send Registration Form", you will get a copy of your filled out form.

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Created by ydm@inaoep.mx on February 20, 2000