HEP2005 International Europhysics Conference on High Energy Physics July 21st to July 27th, 2005 Lisbon, Portugal --------------------------------------------------------------------- LIP reservation Form - Aparthotel Eden deadline: 31-May-2005 --------------------------------------------------------------------- FAMILY NAME: _____________________________________________________ FIRST NAME: _____________________________________________________ INSTITUTION: _____________________________________________________ ADDRESS: _____________________________________________________ _____________________________________________________ PHONE: _____________________________________________________ FACSIMILE: _____________________________________________________ (TYPE AN "X" IN THE SPACES CORRESPONDING TO YOUR CHOICES) Please book me a ___ Studio (1 or 2 persons: 80 Euro + 5 Euro/day/person for breakfast) ___ Double (1 to 4 person: 116 Euro + 5 Euro/day/person for breakfast) 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 Aparthotel Eden P. dos Restauradores, 24 1250-187 Lisboa, Portugal Fax: +351-21-321-6666 Tel: +351-21-321-6600 ---------------------------------------------------------------------