INT PARTICIPANT INFORMATION
Low-Energy Neutrino Physics, INT-99-2
June 28 - September 3, 1999
 
Name:____________________________________________________________

Title:________________________________________________________

Department:___________________________________________________

Institute:____________________________________________________

Address:______________________________________________________

______________________________________________________________

Telephone (Office):_________________(Home):___________________

Email:________________________________________________________

Fax:___________________________________________________________

Preferred length of stay:________ weeks



Mark an 'X' next to the preferred week(s) for your visit.
Week Week
June 28 August 2
July 5 August 9
July 12 August 16
July 19 August 23
July 26 August 30

Topics on which you may wish to give a seminar:

_____________________________________________________________________________

Please list subfields which are of interest to you:

_____________________________________________________________________________

List people with whom you would like your visit to coincide:

_____________________________________________________________________________

Please fax or mail this form to Maria Francom at the address below as soon as possible but no later than January 8, 1999. Or to request an email version contact francom@phys.washington.edu

Institute for Nuclear Theory
University of Washington
Box 351550
Seattle, WA 98195-1550
Tel: 206-685-3509
Fax: 206-685-3730


Return to INT-99-2 Page