WWMM
                     WW Physics Workshop

                   November 1st - 4th, 2000
                      Sesimbra, Portugal 

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                      REGISTRATION FORM
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IDENTIFICATION

      Family Name: ___________________________________________________

       First Name: ___________________________________________________

    Experiment or
    field of work: ___________________________________________________

      Institution: ___________________________________________________

          Address: ___________________________________________________

                   ___________________________________________________

           e-mail: ___________________________________________________

        Telephone: ___________________________________________________

        Facsimile: ___________________________________________________

        Number of
     Accompanying
          Persons: _____

Conference Dinner: _____    Number of Persons: ___        Price/Person
                                                           5,500.- PTE
                                                           (27.4 Euro)
                                                              45.- CHF

 REGISTRATION FEE: 8,000.- PTE (40 Euro), 65.- CHF

PAYMENT

  (TYPE AN  "X"   IN THE SPACES CORRESPONDING TO YOUR CHOICES)
   
  I will pay the Conference fee through the following option: 
    
    ___ Upon arrival on site in portuguese escudos

    ___ CREDIT CARD

        Total amount: _______ Currency: __ PTE __ Euro __ CHF

        ___Visa   ___Eurocard  ___Mastercard  ___American Express 

        Credit card number: _____________________________________

        Credit card name:   _____________________________________

        Expiry date (e.g. 11/00):  ____/____

        Signature:  _____________________________________________


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PRINT and send by FAX or LETTER to	LIP
					Av. Elias Garcia, 14 - 1
					P-1000-149 Lisboa
					Portugal

         Tel: +351-21-797-3880          Fax: +351-21-793-4631