Registration Form

RHIC Winter Workshop 2002 on
"Correlations and Fluctuations in Heavy-Ion Collisions at RHIC"
January 4 - 6, 2002

To be ensured a spot in the workshop, your registration must be received no later than November 1, 2001 and your registration fee must be received by November 30, 2001.

Family name: First name:

Professor Research Associate Graduate student Other

Department:

Institute:

Address:

Office Phone: Home Phone:

Fax: E-mail:

Registration Fee: The registration fee is $20. There will be a salmon dinner on Saturday, January 5th which is $45.

Please send a $20 check payable in US dollars to the "University of Washington" for the registration fee. Please send a $45 check payable in US dollars to "Ivar's Salmon House" for the workshop dinner. If we have not received payment by November 30, 2001 we cannot guarantee your place in the workshop or the dinner. We are unable to accept credit cards.

Send payment to:
INT/RHIC Winter Workshop
University of Washington
Institute for Nuclear Theory
Attn: Laura Lee
Box 351550
Seattle, WA 98195-1550

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