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PRE-REGISTRATION FORM
Last Name
*
First Name(s)
*
Institution
*
Postal Address
*
Email
*
Tel. No.
*
Fax No.
Nationality
*
Working Groups of your interest:
(1)
SUSY
Brane World
Alternate Scenarios
(2)
SUSY
Brane World
Alternate Scenarios
The Registration Fee is US $150. Participants will be informed about the payment method shortly.
*
I will pay the fee.
I need a waiver (please justify in the Financial Support box below).
Accommodation required at International Centre, Goa
*
One person based on double occupancy (US $300)
One person based on single occupancy (US $450)
Two persons (US $600)
I will arrange my own accomodation elsewhere
Arrival Date
Departure Date
Limited financial support may be available for participants from India and young researchers (advanced students/postdocs) from outside India. Preference will be given to those who can arrange partial support from another source. If desired, please specify (below) the quantum/nature of support required and how much you can obtain from other sources. You may also enter here any comments/queries for the organisers.
* - Compulsory Field
