WILHELM UND ELSE HERAEUS-STIFTUNG


To be returned by 30 March 2000 to

 
WE-Heraeus-Stiftung                                              Registration Form
Heike Uebel    
Postfach 1553                                              Fax No.
D-63405 Hanau                                              +49-6181-923-2515
Germany
 

238. WE-Heraeus-Seminar / 10 - 14 July 2000 / Marburg (Germany)

NanoBionics - from Molecules to Applications
 


First Name, Surname       Mrs    Mr........................................................................................
Academic Title .....................................................................................................................
Institution/Company .....................................................................................................................
Department/Division .....................................................................................................................
Address/Street/POBox .....................................................................................................................
Zip/City/State .....................................................................................................................
Phone .....................................................    Fax......................................................
E-mail .....................................................................................................................

 
Accompanying person(s):             .................... (number)
 
 
Arrival at Marburg:       SUN, 9 July 2000 / afternoon / evening
        MON, 10 July 2000 / morning (before 2:00 pm)
        other time (approx.): ..........................................................
 
 
Arrival by:       car
        train
        air (Frankfurt)
 
 
Departure from Marburg:       FRI, 14 July 2000 / after lunch
        other time (approx.): ..........................................................

 
 

Registration Form
- page 2 -


 
Accommodation: Registrant    Accompanying person
(accommodation in double room)   
Extra day
(single/double)
 
  Guest house
(breakfast not incl.) 
DM 650,- DM 220,- DM 60,-/85,-
 
Hotel***
(incl. breakfast)
DM 850,- DM 300,- DM 90,-/140,-
 
Hotel****
(incl. breakfast)
DM 1.200,- DM 350,- DM 160,-/200,-
 
Registrant: Price includes access to the conference, accommodation for four (4) nights 10-14 July 2000, lunch & dinner (beverages not incl.) and excursion.
 
Accompanying person: Accommodation (sharing the room with the registrant) and excursion.
 
Earlier arrival or later departure may be arranged at extra costs payable directly at the hotel/guest house.
Once you have been notified on the acceptance of your registration we kindly ask you to transfer your accommodation costs to our bank account as soon as possible latest by 30 April 2000.
 
Bank account owner:      Wilhelm und Else Heraeus-Stiftung, Hanau
Bank:      Deutsche Bank AG Hanau
Account number:      034566001
Bank code:      506 700 09
Swift address      DEUT DE FF 506
     (Transferring fees to the debit of the registrant)

 
Contribution:       Oral Presentation*
        Poster Presentation*
        Conference Attendance
 
Title of your contribution:       ....................................................................................................
  ....................................................................................................
  ....................................................................................................
 
Special remarks: ....................................................................................................

 

                                                  
City    /    Date    /    Signature
 

*Please do not forget to send your abstract to hampp@chemie.uni-marburg.de.