INT PARTICIPANT INFORMATION

Microscopic Nuclear Structure Theory
INT-04-3
September 27, 2004 - December 3, 2004



Family name: First name:

Professor Research Associate Graduate student Other

Department:

Institute:

Address:

Office Phone: Home Phone:

Fax: E-mail:

Preferred length of stay:

Please check the box next to the preferred week(s) for your visit
(Dates below are Mondays).

Sept. '04Oct. '04Nov. '04
Sept. 27Oct. 4 Nov. 1
Oct. 11 Nov. 8
Oct. 18 Nov. 15
Oct. 25 Nov. 22
Nov. 29

Topics on which you may wish to give a seminar:

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