International Conference on Advanced Monte Carlo for Radiation Physics, Particle Transport Simulation and Applications October 23-26, 2000 Lisbon, Portugal -------------------------------------------------------------------- RESERVATION FORM - RESIDENTIAL IMPERADOR -------------------------------------------------------------------- FAMILY NAME: _____________________________________________________ FIRST NAME: _____________________________________________________ INSTITUTION: _____________________________________________________ ADDRESS: _____________________________________________________ _____________________________________________________ PHONE: _____________________________________________________ FACSIMILE: _____________________________________________________ (TYPE AN "X" IN THE SPACES CORRESPONDING TO YOUR CHOICES) Please book me a ___ Single Room (?,??? PTE/day) ___ Double Room (?,??? PTE/day) Date of arrival: __________ Date of departure: ____________ ___Visa ___Eurocard ___Mastercard ___American Express Credit card number: _____________________________________ Credit card name: _____________________________________ Expiry date (e.g. 11/00): ____/____ Signature: _____________________________________________ -------------------------------------------------------------------- PRINT and send by FAX to RESIDENCIAL IMPERADOR Av. 5 de Outubro, 56 R/c 1050 Lisboa, Portugal Fax: +351-21-352-6537 Tel: +351-21-352-4884 -------------------------------------------------------------------- |