HEP2005 International Europhysics Conference on High Energy Physics
                      July 21st to July 27th, 2005
                           Lisbon, Portugal 
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               LIP  reservation form  -  Hotel Sana Executive
                           deadline: 20-May-2005
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  FAMILY NAME: _____________________________________________________

  FIRST  NAME: _____________________________________________________

  INSTITUTION: _____________________________________________________

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


      Please book me a  ___ Single (71 Euro/day)

                        ___ Double (79 Euro/day)

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    PRINT and send by fax to       Hotel Sana Executive
                                   Av. Conde Valbom, 56
                                   1050-069 Lisboa, Portugal

         Fax: +351-21-795-1166     Tel: +351-21-795-1157
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