Registration Form

NNN99 Workshop

September 23-25, 1999, SUNY at Stony Brook

 Name as it should appear on name badge:

   First: ___________________   Last: ______________________________

   Affiliation: _________________________________________________________________ 

 Mailing Address:

   Institution: _____________________________

   Street: ______________________________________________________________________

   City:   ___________________________  State: _________  Postal/Zip Code: _______

   Country:   ________________________

   Day Phone: ________________________  Fax: ________________________ 

   Email:     _______________________________________________________


 Daily transportation will be provided at no cost between the Holiday Inn Express 
and the campus.
Intend to use this service? ___Yes ___No PARKING: Parking permit needed? ___Yes ___No COMPANION INFORMATION: Will you be accompanied by companions? ___Yes ___No FEES FOR PARTICIPANTS: Registration: Cost if received on or Cost if received before August 31, 1999 after August 31, 1999 (Please circle one:) $175 $200 Includes coffee breaks, welcome reception, the banquet, conference proceedings. ADDITIONAL BANQUET TICKETS: COST: $50 Number of Tickets: ___ SUNDAY THEATRE TRIP: ("Ragtime" at Ford Center for Performing Arts in Manhattan) Single Ticket: $61 (Dress Circle or Orchestra seats) Number of Tickets: ___ Single Ticket: $33 (2nd Balcony seats) Number of Tickets: ___ (Subject to Availability). TOTAL: Please sum all the above amounts: Registration Fee: $ _________ Additional Banquet: $ _________ Sunday Theatre Trip: $ _________ Total: $ _________ Make checks or money orders payable to "SBF 266430". Mail payment and registration form to: Joan Napolitano, NNN99 Workshop Secretary High Energy Physics Group Dept. of Physics and Astronomy State University of New York at Stony Brook Stony Brook, NY, 11794-3800 U.S.A.