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
--------------------------------------------------------------------