Application Form
 


Application Deadline: November 15, 2004

Contact Information:
Professor Sudip Chakravarty
Ref: Aspen Winter Conference
Department of Physics and Astronomy
University of California Los Angeles
Los Angeles, CA 90095-1547
(310) 825 5734 Fax
aspen2005@physics.ucla.edu

 

 

Estimated Conference Costs

Registration:
  $300.00

Housing:
  Single Occupancy - $201/day
  Double Occupancy - $131 /day
  Includes breakfast and dinner
  (Sunday dinner to Friday breakfast)

  Additional Meal Package:
  Adults - $61/day
  Children - please call.

 

Please complete the information below, and click on the "submit" button to send your application.
Please be sure to complete all required fields (*) and provide a valid email address for your confirmation email.

 
Name (first last)*:
Institution*:
Departmet*:
Street Address*:
City/Sate/ZIP*:
E-mail Address*:
Home Phone: Work Phone*: Fax Number:
Special Request:
 

     

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