REGISTRATION


DEADLINE FOR REGISTRATION

Nanophysics : from fundamentals to applications : 

July 9th, 2017
(note that the deadline for "early bird" registration fees payment is:
May 30th)

(hotel reservation is made from this application form by the conference secretariat)

Please fill all the mandatory fields *

(including the anti-spam)

1. Personal Informations

Conference:  Nanophysics : from fundamentals to applications (July 30 - August 5, 2017)
  
Gender: * 
Family Name: * 
First Name: * 
E-mail: *
Professional Status: 
Nationality: * 
Date of birth: 
Are you: 
Field of interest
Collaboration: 

Home Institution

 
Name: *
Street/Bldg: *
City: *
Postal code: *
Country: *
Your Phone: 
Portable Phone: 


2. Address for proceedings shipping
(if different from above)

Street/PObox/etc: 
City: 
Postal code: 
Country: 


3. Hotel Reservation
reminder: hotel reservation is made exclusively by the conference secretariat
and for the whole duration, i.e from Sunday July 30 noon, to Saturday August 5 morning, lunch included

Date of Check-in: *
Date of Check-out: *
Type of room : 
Twin room to be shared with: 
If you have special food requests, please mention it  

Will you be accompanied : 

by your spouse/partner?
Spouse/Partner Name: 
Spouse/Partner First Name: 
Spouse/Partner Gender: 
Spouse/Partner date of birth: 
Spouse/Partner Nationality: 
type of bed

by your children?
Child 1  Name: 
First Name: 
Date of birth: 
Child 2  Name: 
First Name: 
Date of birth: 
Child 3  Name: 
First Name: 
Date of birth: 


4. Arrival / Departure

To help us optimize your transfer from Quy Nhon airport to the Seagull Hotel, please give the following information:
(if the information is not yet available, do not forget to send it later by mail to the secretariat)

Arrival at Quy Nhon airport 
Date: 
Time: 
Flight: 
Departure from Quy Nhon airport 
Date: 
Time: 
Flight: 


5. Excursion

A half-day excursion will be proposed on wednesday morning with 2 options:
EITHER a visit of the Bahn It Cham Towers and to the Quang Trung Museum,
OR scuba diving to see coral at Ky Co Beach (if you choose this second option, then you must fill in the "date of birth" field, in the section "1. Personal Informations").

Which excursion will you choose?

6. Post Conference Tour

Are you interested in a post conference tour?


7. Remarks



Anti-Spam: * please input the result of 111+222