Please fill all the mandatory fields *

(including the anti-spam)

1. Personal Informations

Conference:	3 neutrinos and beyond (August 4-10, 2019)
Gender: *	? M F
Family Name: *
First Name: *
E-mail: *
Professional Status:	Dr Professor Associate Professor Post-doc PhD student Graduate student Other
Nationality: *
Date of birth:  (mandatory for Ky Co excursion)
Are you:	Experimentalist ? Experimentalist Theorist Observer
Field of interest
Collaboration:
Home Institution
Name: *
Street/Bldg: *
City: *
Postal code: *
Country: *
Your Phone:
Portable Phone:

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2. Hotel Reservation
reminder: hotel reservation is made exclusively by the conference secretariat
and for the whole duration, i.e from Sunday August 4 noon, to Saturday August 10 afternoon

Date of Check-in: *
Date of Check-out: *
Type of room :	? Single Double shared with participant Double shared with my spouse/partner
Twin room to be shared with:
If you have special food requests, please mention it	? No special request Vegan meals Vegetarian meals (fish accepted)

Will you be accompanied : 

by your spouse/partner?		No No Yes
Spouse/Partner Name:
Spouse/Partner First Name:
Spouse/Partner Gender:		? M F
Spouse/Partner date of birth:
Spouse/Partner Nationality:
type of bed		Twin beds Twin beds Couple bed
by your children?		0 0 1 2 3
Child 1	Name:
First Name:
Date of birth:
Child 2	Name:
First Name:
Date of birth:
Child 3	Name:
First Name:
Date of birth:

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3. 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:

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4. Excusion

A half-day excursion will be proposed on wednesday afternoon 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? Cham Towers Cham Towers Ky Co

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5. Post Conference Tour

Are you interested in a post conference tour? No Yes: Tour1 Yes: Tour2 Yes: Tour3 Yes: Tour4

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6. Remarks

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

? 123 333 789