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Name:  Prof./Dr./Mr./Ms.                            [  ] Male                               [  ] Female

___________________               ________________________               __________
Surname                                          First Name                                           Middle Initial

Address:    ________________________________________________________

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      City                         State                                   Zip Code                    Country

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Telephone (include area code/country code)                 FAX                      e-mail

Please check one of the following:

[  ] Registration fee, received on or before July 1, 1999; U. S. $400.00.

[  ] Registration fee, received after July 1, 1999; U. S. $450.00.

Please make checks payable in U. S. dollars to Virginia Commonwealth University.  The checks must be drawn on U. S. banks.  Otherwise a surcharge will be collected from the participant.

If you wish to pay by a credit card, please fill out the following. Also for your your own protection, please do not send this information by e-mail.

Credit Card Type:                         [  ] Master Card                               [  ] Visa

Credit Card Number________________________________________________
        
Expiration Date__________________________

Authorizing Signature_______________________________________________
 

Since the number of participants is limited due to the size of the meeting room, it is advisable to register as early as possible.

Please print off this form from your browser and fill it out and mail it with your check to:    

        ISCANI 
        c/o Dr. P. Jena 
        Physics Department 
        Virginia Commonwealth University 
        Richmond, Virginia 23284-2000
        U.S.A.