Joint ICFA Advanced Accelerator and Beam Dynamics Workshop
The Physics & Applications of High Brightness Electron Beams
Chia Laguna, Sardinia July 1-6, 2002

REGISTRATION FORM


PLEASE print fax THIS completed SIGNED (very important) form to Melinda Laraneta at + (310) 206-5251

Please complete:

NAME:__________________________________________________________________________________________________

INSTITUTION:___________________________________________________________________________________________

ADDRESS:______________________________________________________________________________________________

CITY:_______________________________________________STATE/REGION:_____________________________________

COUNTRY:__________________________________________ZIP CODE/POSTAL CODE:____________________________

EMAIL:_________________________________________________________________________________________________

PHONE:___________________________________________________________FAX:_________________________________

Registraiton fee:                  

*          $425 if received before June 15, 2002

*          $500 if received after June 15, 2002

Please check and complete:

We accept checks and money orders only, made payable to: UC REGENTS
Send check or money order to Melinda Laraneta at:

UCLA, Department of Physics & Astronomy, Los Angeles,
CA 90095-1547, USA.

MY PAYMENT IS ENCLOSED: ____

MY INSTITUTION IS SENDING PAYMENT: ____

*I WILL PAY UPON ARRIVAL AT CHIA LAGUNA: ____ (450 Euros)

 *Payment at registration must be made in Euros and arranged in advance. Please send your request to Melinda Laraneta:  laraneta@physics.ucla.edu.

Hotel Reservations:

The Grand Hotel Chia Laguna is a full service hotel and resort. All rooms are double rooms. The cost of your room at half board includes breakfast and dinner; full board includes breakfast, lunch and dinner. The cost of the rooms in Euros, including tax, is as follows:

Double Room with Half Board (Breakfast, Dinner):
115Eu x .88885 = $102.22/1.2* = $85.18/person/night (pre tax)

    115.00 Euros

Double Room with Full Board (Breakfast, Lunch, Dinner):
135Eu x .88885 = $120.00/1.2* = $100.00/person/night (pre tax)

    135.00 Euros

Single Room with Half Board (Breakfast, Dinner):
145Eu x .88885 = $128.89/1.2* =$107.41/night (pre tax)

    145.00 Euros

Single Room with Full Board (Breakfast, Lunch, Dinner):
165Eu x .88885 = $146.66/1.2* = $122.22/night (pre tax)

    165.00 Euros

*Value Added Tax on hotel accommodations of 20%.

Children up to 12 (same room as parents): 50%, up to 2 years old free.

Please complete the following to reserve your room with Master Card or Visa:

NUMBER OF ROOMS: __________                    NUMBER OF GUESTS:_________

DATE OF ARRIVAL: _________________    DATE OF DEPARTURE:______________

SPECIAL NEEDS:________________________________________________________

CREDIT CARD TYPE: ________________   EXPIRATION DATE: _______________

CREDIT CARD NUMBER:__________________________________________________

________________________________________________________________________
Signature

Please Note: in case of a no show your credit card will be charged with two (2) days of room charge. Reservation cancellations after May 31st will be charged one (1) day room charge

Please select the bus of your choice and indicate the number of passengers:

JUNE 30: Depart Cagliari Airport to G.H. Chia Laguna:

        11:30 _____17:45 ____21:45 ____        NUMBER OF PASSENGERS: ____

JULY 06: Depart G.H. Chia Laguna to Cagliari Airport:

        09:30 _____13:00 ____                      NUMBER OF PASSENGERS: _____

JULY 07: Depart Bus Departing Chia Laguna for Cagliari Airport

         09:30 _____                                   NUMBER OF PASSENGERS: ______

 I DO NOT NEED BUS TRANSPORTATION: ____

 

______________________________________________________________________________________________________
Signature & Date
( Please make sure you have signed this document before faxing.)

Please fax your completed form to Melinda Laraneta at + (310) 206-5251.