Workshop "Supergeometry" 
             Laboratoire de Mathématiques et Applications de Metz
                            (UMR 7122 du CNRS)
                      Université Paul Verlaine - Metz

                            June 18-19, 2009

                           REGISTRATION FORM

Please fill out this registration form and sent it by email 
before June 1, 2009, to Mme Isabelle Naviliat to the address 
Isabelle.naviliat@univ-metz.fr

LAST NAME:
FIRST NAME:
AFFILIATION: 
EMAIL ADDRESS: 
_____________________________________________________________________

PARTICIPATION TO THE WORKSHOP DINNER: YES - NO
(researcher: 25 euros ; PhD students: 15 euros)
Special meal requirements: 
_____________________________________________________________________

HOTEL RESERVATION:  YES - NO
Hotel:  
Arrival date:
Number of nights:
Number of persons:
Number of rooms:
Please indicate the number and type of requested rooms:
     Single room 
     Double room 
     Double room (2 beds) 

Additional information: