%%%%%%%%%%%%%%%%%%%% Hirschegg  Application Form %%%%%%%%%%%%%%%%%%%%%%%%%%
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%%%%%%%%%%%%%%%%%%%% Hirschegg  Application Form %%%%%%%%%%%%%%%%%%%%%%%%%%
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\underline{\Large {\sc Hirschegg\phantom{,}'97:} \hfill
QCD PHASE TRANSITIONS}\\[5mm]
APPLICATION and REGISTRATION FORM\\
(Dead line: Oct.~31, 1996)\\[5mm]
\end{center}
Hirschegg Workshop\\
c/o Frau E. Rass\\
Gesellschaft f\"ur Schwerionenforschung\\
Postfach 110 552\\
D-64220 DARMSTADT\\
Germany\\[.4cm]
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I plan to attend the International Workshop XXV on Gross Properties of
Nuclei and Nuclear Excitations at Hirschegg, Kleinwalsertal, Austria,
January 13 - 18, 1997.\\[0.3cm] \usebox{\kk} I like to present a
contribution entitled\\[0.6cm] 
.\dotfill .\\[4mm]
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\begin{tabular}{lll}
\hspace*{-2mm}An abstract (one page maximum) is& 
\usebox{\kl} & attached\\ & 
\usebox{\kl} & e-mailed (LaTeX or PostScript file)\\[0.2cm]
\end{tabular}\\
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Number of accompanying persons:\hspace*{4mm}  
\usebox{\kk}\\[0.2cm] 
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For accommodation I prefer\\[0.2cm] 
\usebox{\kk} \fbox{\parbox{15cm}{
{\bf Waldemar-Petersen-Haus}
(mountain lodge, preferably for participants without accompanying
persons, full board, the whole week January  12 - 18 must be paid) \\
   \parbox[t]{7.5cm}{\usebox{\kl} single room (420 DM/week) \\
                     \usebox{\kl} double room (380 DM/week)} \hfill
                     \usebox{\kl} four-bedded room (340 DM/week)}}\\[2mm] 
%----------------------------------------------------------------------
\usebox{\kk} \fbox{\parbox{15cm}{
{\bf nearby boarding house}(breakfast only, $\approx$ 60 DM/day)\\ 
       {\em optional}:~~ \usebox{\kl}\parbox[t]{11cm}
                     {lunch and dinner in Waldemar-Petersen-Haus\\ 
                      (for participants only, $\approx$ 160 DM/week)}}} \\[2mm]
%----------------------------------------------------------------------
\usebox{\kk} \fbox{\parbox{15cm}{{\bf hotel} (rooms with bath, half
                                  board, $\approx$ 100 DM/day)\\
{\em optional}:~~ \usebox{\kl} lunch in Waldemar-Petersen-Haus  
                               ($\approx$ 70 DM/week)}} \\[2mm]
%----------------------------------------------------------------------
\usebox{\kk} \fbox{\parbox{15cm}{{\bf Hotel Ifen} (half board, 
                                  $\approx$ 180 DM/day)\\
{\em optional}:~~ \usebox{\kl} lunch in Waldemar-Petersen-Haus  
                                ($\approx$ 70 DM/week)}}\\[.5cm]
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Date of arrival: \dotfill\hfill Date of departure: \dotfill\hfill$ $\\
                 \hrule\vspace*{4mm}
In addition we ask for a conference fee of 120 DM.\\
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Name:       &.\dotfill .& \hspace*{3mm} \usebox{\kl}male&
                                        \usebox{\kl}female \\[3mm]
First name: &.\dotfill .&                      &           \\[3mm]
Institution:&.\dotfill .& \hspace{3mm}  e-mail:&.\dotfill .\\[3mm]
Address:    &.\dotfill .& \hspace{3mm}  Phone: &.\dotfill .\\[3mm] 
            &.\dotfill .& \hspace{3mm}  Fax:   &.\dotfill .\\[3mm]
	    
\end{tabular}
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