Registration Form

Registration Form (Deadline:30.11.1999 )

Please complete (type or use capital letters) and return to:

Institute for Low Temperature Physics & Engineering, 47, Lenin ave., 310164, Kharkov, Ukraine,

Phone:+380-(572)-321-223, Fax:+380-(572)-322-370; +380-(572)-335-593, E_mail:ASI-2000@ilt.kharkov.ua

Family Name	__________________________________
First Name and Initials	__________________________________
Title (circle one)	Prof. Dr. Mr. Ms. Mrs.
Year of birth	__________________________________
Company/University	__________________________________
Department/Institute	__________________________________
Street	__________________________________
P.O.Box	__________________________________
Zip Code	__________________________________
City	__________________________________
Country	__________________________________
Phone	__________________________________
Fax	__________________________________
E_mail	__________________________________
Accompanying persons	__________________________________
Section, in wich you would like to participate	__________________________________
Topic of your report at a plenary sitting	__________________________________
Topic of your speech at the section	__________________________________
Topic of your open lesson	__________________________________
Pupils' age	___________________________________

For the report I will need following equipment

Overhead projector	__________________________________
Slide projector	__________________________________
TV-set and video taperecoder	__________________________________
Other equipment	___________________________________
Please send the Invitation and Registration Form also to (name, address and telefax)	__________________________________
Date, Signature	__________________________________