Application Form

I wish to attend the ATLAS international symposium
Spa Balmoral-Belgium
Thursday 13 & Friday 14 March 2008

	Mr. Mrs.
Name
Institution
Department
Address
City, Postal Code
Country
Tel
Fax
E-mail Address

Special requests

	I enclose a paper abstract
	Vegetarian meals requested
	I'm interested in chairing one of the workshops

Conference fee

	ATLAS members fee for 2 days	€ 250
	ATLAS members fee for 1 day	€ 150
	Non-ATLAS members fee for 2 days	€ 275
	Non-ATLAS members fee for 1 day	€ 175
	Students symposium program fee for 2 days	€ 100
	Students symposium program fee for 1 day	€ 50

I am a member of ATLAS

Form of payment

As soon as you have been registrated an invoice/receipt will be send.

	I wish to pay by bank transfer
	I wish to pay by credit card (Euro Card Master Card, Visa Card, American Express Card). Please contact the ATLAS secretariat at: admin@atlas-euro.org

If you wish an invoice for the attention of someone else, please give the name for the invoice:

Biosketch / CV

For the creation of a detailed delegate list, please fill in this textbox with a small biosketch / CV of not more then 35 words.

Remarks

If you have any remarks, please enter them over here.

Cancellation policy

If written cancellation is received before 15^th of January 2008, a refund of all meeting fees will be made, minus an administration fee of € 25. No refund will be possible after 15^th of January 2008, but substitute delegates can be nominated.