Interfacing Structure and Reactions at the Centre of the Atom

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Post Kernz08

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Kernz08 Pre-registration Questionnaire

Please return to Ian Thompson, questionnaire@kernz.org
(Word version - preferred).

 Name:
Position:
Affiliation:
Address:


Email:
Phone:
Fax:

  1. I plan to attend:    [  ]Yes  [  ]No  [  ]Maybe
  2. Areas of research expertise/interest (tick which apply);

[  ]Theory [  ]Experiment [  ]Astrophysics [  ]Structure [  ]Reactions [  ]Other – specify:

  1. I will need accommodation at the Millennium Hotel
       [  ]Yes [  ]No  [  ]Maybe
    Note: Conference Dates are Sun, Nov 30 (evening) – Friday, Dec 5 (1 pm).
  2. I will bring: [  ] a companion, [  ](#) children
  3. [  ] I would like to share a room with another participant

Preference, if any:                   [  ]Use sharing webpage to be set up later

  1. I am interested in a half-day excursion during the conference: (select two if desired)

*     Steamer on Lake Wakitipu: [  ] Yes [  ] No [  ]Or Sun, Nov 30

*     Dart River Safaris:       [  ] Yes [  ] No [  ]Or Sun, Nov 30 - dartriversafaris.co.nz

*     Jet boat on Shotover River : [  ] Yes [  ] No [  ]Or Sun, Nov 30 - shotoverjet.co.nz

*     Wine Tour:     [  ] Yes [  ] No [  ]Or Sun, Nov 30 - appellationcentral.co.nz

*     Lord of the Rings Tour:           [  ] Yes [  ] No [  ]Or Sun, Nov 30 - lordoftheringstours.co.nz

*     Other – specify:
 

  1. I plan to attend the conference dinner: [  ] Yes [  ] No [  ](#) people
     
  1. I am interested in presenting a talk or poster: [  ]Yes  [  ]No

Preference: [  ]oral presentation [  ]poster

  1. Preliminary title of the presentation and either a preliminary abstract or a brief (1-2 sentence) description of the topic:

 

 

  1. I have the following additional suggestions for the workshop organization or speakers:



Pre-registration Questionnaire
Please return to Ian Thompson, questionnaire@kernz.org

Home: www.kernz.org      Physics Contact: Programme@kernz.org        Local Contact: Local@kernz.org