"Second Conference on the Exact Renormalization Group"

Hotel Reservation Form

HOTEL _________________________________

Dear Sir/Madam,
        We would like to reserve a room as follows:



Expected day and hour of arrival: Day:_________________________ Hour:_______________

Expected day and hour of departure: Day:_________________________ Hour:_______________
Single Room [ ]
Double Room [ ]

Mr.[ ] Ms.[ ] Last Name:___________________________First Name:_________________

Sharing room with:__________________________________________________________

Institution address:__________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Tel:______________________________Fax:______________________Email:__________



Signature:_________________________________________Date:___________________