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



Estimated Conference Costs


  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)*:
Street Address*:
E-mail Address*:
Home Phone: Work Phone*: Fax Number:
Special Request:


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