INT PARTICIPANT INFORMATION
Low-Energy Neutrino Physics, INT-99-2
June 28 - September 3, 1999

Name:____________________________________________________________

Title:________________________________________________________

Department:___________________________________________________

Institute:____________________________________________________

Address:______________________________________________________

______________________________________________________________

Telephone (Office):_________________(Home):___________________

Email:________________________________________________________

Fax:___________________________________________________________

Preferred length of stay:________ weeks

Mark an 'X' next to the preferred week(s) for your visit.

Week		Week
June 28		August 2
July 5		August 9
July 12		August 16
July 19		August 23
July 26		August 30

Topics on which you may wish to give a seminar:

_____________________________________________________________________________

Please list subfields which are of interest to you:

_____________________________________________________________________________

List people with whom you would like your visit to coincide:

_____________________________________________________________________________

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Please fax or mail this form to Maria Francom at the address below as soon as possible but no later than January 8, 1999. Or to request an email version contact francom@phys.washington.edu

Institute for Nuclear Theory
University of Washington
Box 351550
Seattle, WA 98195-1550
Tel: 206-685-3509
Fax: 206-685-3730