HEP2005 International Europhysics Conference on High Energy Physics
                      July 21st to July 27th, 2005
                           Lisbon, Portugal 
  ---------------------------------------------------------------------
              LIP  reservation form  -  Hotel do Campo Grande
                           deadline: 24-Jun-2005
  ---------------------------------------------------------------------

  FAMILY NAME: _____________________________________________________

  FIRST  NAME: _____________________________________________________

  INSTITUTION: _____________________________________________________

      ADDRESS: _____________________________________________________

               _____________________________________________________

        PHONE: _____________________________________________________

    FACSIMILE: _____________________________________________________


     (TYPE AN  "X"   IN THE SPACES CORRESPONDING TO YOUR CHOICES)


      Please book me a  ___ Single (79 Euro/day)

                        ___ Double (84 Euro/day)

   Date of arrival: ____________   Date of departure: _____________



       ___Visa   ___Eurocard  ___Mastercard  ___American Express 

       Credit card number: _____________________________________

       Credit card name:   _____________________________________

       Security Number:    _____________________________________

       Expiry date (e.g. 11/06):  ____/____


       Signature:  _____________________________________________

          
  ---------------------------------------------------------------------
    PRINT and send by fax to       Hotel Do Campo Grande
                                   Campo Grande, 7
                                   1000 Lisboa, Portugal

         Fax: +351-21-797-4761     Tel: +351-21-791-7690
  ---------------------------------------------------------------------