Registration Form

International Workshop on Atomic Collisions and Atomic Spectroscopy with Slow Antiprotons

Please fill in the registration form below and send it to the following address, preferrably via e-mail.

Prof. Yasunori Yamazaki
Antiproton Workshop
Institute of Physics, University of Tokyo, Komaba
3-8-1, Komaba, Meguro-ku, Tokyo, 153-8902, Japan

phone: 03-5454-6521
fax: 03-5454-6433
e-mail: pbar99@radphys4.c.u-tokyo.ac.jp

Title ............ First name(s) .........................................

Family name ..............................................................

Affiliation ..............................................................

..........................................................................

Address ..................................................................

..........................................................................

Postal code ..................... City ............................................

Country ..............................................

Phone ................................. Fax .....................................

E-mail ...............................................

Accompanying person's name: ..............................................

I plan to attend the Workshop: .................................................................

I am interested in receiving the 2nd circular: .................................................................