Workshop in Relativistic Quantum Mechanics

January 15-19, 1996
Registration Form

Name: _________________________Title/Position_______________________

Department/Division____________________________________________________

University/Organization________________________________________________

Street Address_________________________________________________________

City________________State_____________Zip Code___________

Telephone_____________________________FAX________________

E_mail address___________________________________________

Registration type (check one)

Regular__________$50.00

Student__________$25.00

Deadline for registration is January 5, 1996

Receipts will be mailed.

If you would like access to PNNL facilities to meet with staff members during your stay AND you are a foreign national , some additional information is required:

Citizenship:_____________________Do you have a greencard?_________

Date of Birth:___________________Place of Birth:__________________

Male:_______Female:______________

Passport #:______________________Expiration date:_________________

Send completed forms to:

Deborah S. Baker
Environmental Molecular Sciences Laboratory
Pacific Northwest National Laboratory
906 Battelle Blvd, K1-83
Richland, WA 99352
Phone: (509) 375-6450 FAX: (509) 375-6631

ds_baker@pnl.gov