6th ATLAS MUON WEEK

June 10-17, 2001 Gaeta, Italy

ACCOMODATION FORM

Please type or write in CAPITAL LETTERS and send by fax before 30 April 2001 to Hotel Summit (Fax: +39.0771.741741)

PARTICIPANTS
Surname   ________________________ First name  ______________________________
Mailing Address:  _________________________________________________________
City   _______________________  State   _________   Code   ___________   Country  __________________
Telephone   _____________________   Fax   __________________  
E-mail  _________________________

HOTEL ACCOMMODATION

 Arrival Date   ___________________   Departure date   ____________________  
 Number of days   ___________  

  ( ) Single Room (240.000)   -    ( ) Double Room (190.000)

 Double room - sharing with   _______________________________________

 Rates per person and per day are expressed in Italian Lire

PAYMENT
( ) Please charge the amount of   _______________ to my credit card.:
         ( ) American Express      ( ) Visa      ( ) Diners Club      ( ) Mastercard
Credit Card number   _________________________________   Expiry date  ______________

Registered Name of Card Holder   __________________________________________________
Authorized address of Card Holder   ________________________________________________

Cancellation Policy (for accommodation): Refunds will be made if a written notification is received as follows:
        - Until, 21/5/2001: Full refund less 100.000 lire for handling fee.
        - No refund will be given thereafter.

Signature   _____________________________  Date  ________________