ICHMT International Symposium on Radiative
Transfer, 20 - 25 June, 2004
REGISTRATION AND ROOM RESERVATION
Family
Name: ________________________________ Other
Names: ______________________________________________
Affiliation and Address: _________________________________________________________________________________
_________________________________________________________________________________
Tel:
____________________ Fax: ____________________ E-Mail:
__________________________________
[ ] Request
bound paper copy of the Symposium Proceedings at an extra charge of US$ 50
to be paid on site
[ ] Accompanied by Spouse and
____ children aged _____
Room
Request
[ ] The Marmara Hotel [ ] Taksim Square
Hotel [ ] Cartoon Hotel [ ] Germir Palas Hotel
____ nights
from: / / 2004
to: / / 2004
[ ] Single Rm [ ]
Double Rm [ ]
Triple Rm
[ ]
Shared by family [ ]
Shared by another participant(s)
Full
name of the other participant(s) if you have a preference: ________________________________________
Date:
______________________________
|
Registration fee $
______ | [ ]
I enclose a bank check payable to Faruk Arinc; or
|
Accommodation ( __
nights x US$ ______ = ) $
______ | [ ]
I enclose a copy of the bank transfer document; or
|
Total
$ ______ |
[ ] Please charge my credit card
for the above total amount
|
Note:
See the second page for details of the payment. In case of late cancellation, US$ 50 from the registration fee and one-night stay in the hotel will be deducted and the rest will be refunded.
CREDIT CARD PAYMENT
Please
charge ________ US Dollars to my [ ] Visa
[ ] MasterCard [ ] Eurocard
Card
Number: __ __ __ __ __ __ __ __ __ __ __ __
__ __ __ __
Expiry
Date : ___________________________
Signature
: _____________________ Date: _____________________
Name
as shown on Credit Card: ________________________________________
TRAVEL SCHEDULE
Family
Name: ________________________________ Other
Names: ______________________________________
Arrival Date :
____________________ Departure
Date : ____________________
Arrival Time :
____________________ Departure
Time : ____________________
Flight No :
_______________________ Flight
No : _________________________
From : __________________________ To:
_______________________________
(last point of departure) (first destination)
Number
in the party : ________
Name(s)
of the accompanying person(s) :
____________________________________________________________________
This
form is to be filled out and sent to ICHMT Secretariat by fax (+90-312-210
1331), email (arinc@ichmt.org), or snail mail.