Lie Days in Martina Franca

LieGrits logo               Martina Franca, ITALY - May 22-27, 2006               LieGrits logo



REGISTRATION FORM - for Invited Speakers only

Once submitted, your data cannot be modified from the Web: if you wish to change them, please contact us at mf2006"at"mat.uniroma1.it.



Fields with a * are compulsory ones.
 
Name *   Surname *
Age *     Sex *
Affiliation *     E-mail *
Mail address *     City *
Zip-code *   Country *
Telephone     Fax
              Other address (if any) to which you might wish to be contacted:
              Member of the European network "LieGrits" *
Arrival: * Departure: *
        Your last meal at the hotel will be *
        Do you prefer a simple or a double room? *
  Would you accept to share your room with another participant? *
  If "YES", give the name (if any) of a person to share the room with:
You will come by Further remarks

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