INT PARTICIPANT INFORMATION

Fundamental Symmetries and Weak Interactions
INT-02-3
September 30 - December 6, 2002

To be ensured consideration for this program, please submit your application no later than February 4, 2002. The program organizers will review applications at that time, and invitation letters will be issued shortly thereafter.

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. '02Oct. '02Nov. '02Dec. '02
Sept. 30Oct. 7 Nov. 4 Dec. 2
Oct. 14 Nov. 11
Oct. 21 Nov. 18
Oct. 28 Nov. 25

Topics on which you may wish to give a seminar:

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