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    **                                                            **
    **  FIRST INTERNATIONAL WINTER SCHOOL ON HIGH ENERGY PHYSICS  **
    **               Cusco, 1 - 13 August, 1994                   **
    **                                                            **
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                       PRE REGISTRATION FORM


  Prof/Dr/Mr/Mrs/Miss (*) 
  
  Family Name:.......................First Name:.........................
  
  Mailing Address........................................................
  .......................................................................
  .......................................................................
  
  Telephone:......................   Fax:................................
  
  E-mail:.........................

  
  I expect to be accompanied: (*)
       - By my spouse:   Name &  First Name .............................

       - By my children: Age .... First Name.............................
                             ....           .............................
                             ....           .............................

  Expected dates of arrival & departure:
                             arr. .......................................
                             dep. .......................................

  I intend to stay in Lima:(*)
                         Before/After the event..........................
                         Number of days..................................

  Expected mode of transport:(*)
                             Air/Rail/Bus

  I accept to share my room with another participant:(*)
                             Non smoker........   Smoker........

  Special requests:(*)
   I am handicapped and have the special needs explained below.

   Please make reservations for me and accompanying persons on flights:
       Lima-Arequipa-Cuzco-Lima     Lima-Cuzco-Lima
      

  PLEASE SEND THIS PRE-REGISTRATION FORM AS SOON AS POSSIBLE TO:
         A. Castillo M.
         Av. Honorio Delgado 430 Lima31, Peru
         Fax: ++51 +14 823435
         E-mail: dfm@upch.edu.pe

  
  (*) Please delete where necessary.
-- 
Departamento de Fisica y Matematicas                Tel +(51 14) 820252 Ext 47
Universidad Cayetano Heredia, Apdo. 4314 Lima 100 Peru     Fax +(51 14) 823435


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