REGISTRATION FORM
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                 AFRICAN NEUTRON DIFFRACTION MEETING  21-22 AUGUST 2003
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 Title: _ _ _ _ _ _ _ _ _ _ _       First Names: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Surname:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Organisation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Postal Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 


                 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Postal/Zip Code:  _ _ _ _ _ _ _ _ _    Country: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 e-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Tel: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _    Fax: _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _


 I will be accompanied by: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Dietary requirements: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 


 Preferred accommodation:               Single _ _ _ _ _ _       Shared  _ _ _ _ _ _


 Number of nights accommodation: _ _ _ _ _ 


 I would like to share with: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


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 PRESENTATION:                Poster _ _ _ _        Oral _ _ _ _        None _ _ _ _


 Title:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


      _ _ _ _ _ _  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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 Flight information:

 Arrival (date, time and flight number): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Departure (date, time and flight number): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


 Transport between Johannesburg Int. Airport and Amanzingwe required: Yes _ _ No _ _