THE MILLENNIUM 2004 SCHOOL ON NUCLEAR AND PARTICLE PHYSICS AND APPLICATIONS

to be held at Ithala Conference Centre, Ithala Game Reserve, Zululand

11 January - 18 January 2004
 

 

Registration Form

notes

1. STUDENTS intending to attend the school must please fill in SECTIONS A, B, C, D, and E below. Post, fax or e-mail the completed registration form to:

Mr. Thulani Jili  
co-Chairman The Millennium 2004 School
Department of Physics, University of Zululand, Main campus,Private Bag X1001, KwaDlangezwa 3886
Tel: (035) 902-6559, fax: (035) 902-6451
e-mail: tjili@pan.uzulu.ac.za
 

(Please note: this completed form (excluding section F) must reach the organisers on before 10 October 2003. After this date a late registration fee is applicable.)

2. ONCE YOUR TRANSPORT ARRANGEMENTS HAVE BEEN FINALISED please fill in section F and e-mail, post or fax it to the address given above as soon as possible. (Please note: section F of the registration form must reach the organisers before 10 December 2003 in order to allow time to organise shuttle arrangements)

3. PLEASE Let the organisers know As Soon As Possible if there are any changes in your registration details.
 
 

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Section A: General Details

Surname:__________________________________________

First Name(s):______________________________________

Title (Ms,Mr,Dr etc.):___________

From which institution are you ?:_______________________________

contact details (students please fill in section B instead):

address: _________________________________________________

             _________________________________________________

             _________________________________________________

             _________________________________________________

tel.(w) (include code):__________________________________

fax.(w) (include code):__________________________________

E-mail address:__________________________________________

Meal preferences (normal,halaal,kosher,vegetarian etc.):___________________
 
 

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Section B: Students must please fill this section in.

Present Course of Study:________________________

Present Year of Study:____________________________

Institution where you are studying:____________________________

Name and e-mail address of the head of your Physics department:

name :_______________________________

e-mail:______________________________

Name and e-mail address of your supervisor (for post-graduates):

name :_______________________________

e-mail:______________________________

Contact details (during university term):
postal address:_________________________________________________

                     _________________________________________________

                     _________________________________________________

tel.(h) (include code):___________________________________

E-mail address:__________________________________

Contact details (home/permanent address):
postal address:_________________________________________________

                     _________________________________________________

                     _________________________________________________

tel.(h) (include code):___________________________________
 
 

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Section C: Accommodation

How many persons accompanying you will also require accommodation and meals ? _________

make crosses in the boxes to indicate when YOU want to overnight at Ithala and when you need meals.
If you have accompanying persons also make ticks in the boxes to indicate when they want to overnight at Ithala
and when they need meals.

                                       Breakfast                   Lunch               Supper             Overnight

  Sun 11 January                                                                         [    ]                     [    ]

  Mon 12 January            [    ]                           [    ]                  [    ]                     [    ]

  Tue 13 January               [    ]                           [    ]                   [    ]                    [    ]

  Wed 14 January             [    ]                            [    ]                  [    ]                    [    ]

  Thu 15 January               [    ]                           [    ]                   [    ]                    [    ]

  Fri 16 January                [    ]                           [    ]                   [    ]                    [    ]

  Sat 17 January                [    ]                           [    ]                    [    ]                    [    ]

 Sun 18 January                [    ]                          [    ]                   
 

 Are you willing to share a room with a school attendee (Yes or No)?__________

If you answered No, we will try our best, but cannot guarantee, that we can secure you a single room.

If you answered Yes, do you wish to share a room with anyone in particular (Yes or No) ? ___________

If Yes, specify who you want to share with:

name:___________________________________

e-mail address:_____________________________
 

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Section D: Specify any special requirements

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________
 

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Section E: Transport detail (to be filled in by those requiring transport from Vryheid to Ithala and back)

Once your transport arrangements have been finalised please fill in the section below and e-mail, post or fax it to the address given below as soon as possible.

Mr. Thulani Jili  
co-Chairman The Millennium 2004 School
Department of Physics, University of Zululand, Main Campus,Private Bag X1001, KwaDlangezwa 3886
Tel: (035) 902-6559, fax: (035) 902-6451
e-mail: tjili@pan.uzulu.ac.za

or

Dr. E. Sideras-Haddad
co-Chairman The Millennium 2004 School
Schonland Research Centre, Wits University, Wits 2050, Private Bag 3, Johannesburg
Tel: (011) 717-6922/3 , fax: 011 - 717-6932
e-mail: Haddad@src.wits.ac.za.

(Please note: this section of the form must reach the organisers before 10 December 2003 in order to allow time to organise shuttle arrangements)

Surname:___________________________________________

First Name(s):_________________________________________

When will you be arriving in Vryheid? (Month, Day) _________________

when will you be leaving Vryheid? (Month, Day) _________________

Which mode of transport will you use to get to Vryheid? (please circle what is applicable to you)

plane / train / bus / taxi / other

iIf you are using a plane please specify:
 

Meeting Point: Magistrate's Court at Vryheid
                                   

For Lecturers flying to Durban we can provide transport from Durban airport to Ithala. Please fill the information below:

Arrival:

arrival time :____________________________________________

airline :_____________________________________________

flight no. :_____________________________________________

Do you need to be shuttled from Durban airport to Ithala? (Y or N) ________________

How many accompanying persons ? ___________________
 

Departure:

departure day at Durban airport:__________________________

departure time :_______________________________

airline :_______________________________

flight no. :_______________________________

do you need to be shuttled to Durban airport ? (Y or N)_________________________

How many accompanying persons ? __________________

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