Form DISC.PM.CWI 14-16 March 2011 | CWI Amsterdam | Research in mathematics and computer science

Family name:

First name and inital(s):

Gender:

male

female

Department:

University or Institute:

Street or PO Box:

Mailing code:

City:

Country:

Telephone:

E-mail:

Reservation Hotel room:

Sunday, 13 March (night from 13 to 14 March)

Monday, 14 March (night from 14 to 15 March)

Tuesday, 15 March (night from 15 to 16 March)

Please contact Martine Anholt if you need a different reservation. Leave the boxes blank in case no hotel room is needed. Costs of accommodation: hotel room at Hotel Casa 400: EUR 110,- night, including breakfast, excl. tourist tax. www.hotelcasa400.nl. Please contact Martine Anholt if you prefer a different hotel. The hotel costs have to be paid by the guests directly to the hotel at check-out time. In case a guest does not show up or cancels too late, then the costs will be charged to the corresponding team. The hotel room reservation will be confirmed by Martine Anholt.

Type of room:

single

double

When double shared with:

Please click those meals in which you plan to participate.:

Dietary restrictions:

Dietary restrictions (if any), for example "vegetarian", "no pork".