5th Franz Volhard Symposium

Accomodation Reservation Form

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Please complete and return before Wednesday July 15, 1998 to:

Susanne Meißmer
Conference Secretariat
5th Franz Volhard Symposium
Volksgartenstr. 24	Fax ++49 211 789715
D-40227 Düsseldorf	E-mail: [email protected]

Last Name	.....................................................................................................................
First Name(s)	.................................................................................................................... O Male O Female
Institute	....................................................................................................................
Department	....................................................................................................................
Street	....................................................................................................................
Zip code / City	....................................................................................................................
Country	....................................................................................................................
Daytime Phone	....................................................................................................................
Fax	....................................................................................................................
E-mail	....................................................................................................................
Any Dietary Requirements (e.g. Vegetarian):	.................................................................................................................... ....................................................................................................................
Facilities required:	O single room O double bed room - I share the room with .................................................................
O	Yes, I want to stay one extra day - DEM 100.00 extra Please specify: O September 02-03, 1998 (Wednesday to Thursday) O September 06-07, 1998 (Sunday to Monday)
Any Disabilities/ Special Requirements:	.................................................................................................................... ....................................................................................................................

Accomodation Address:

Conference Hotel Döllnsee-Schorfheide
Döllnkrug 2
D-17268 Groß Dölln

Contact telephone number during the conference 49-(0)3337-63-0!

Please Note: The registration fee includes accomodation and meals served during the conference (Thursday September 3 to Sunday September 6, 1998) - see registration form. All other expenses incurred, such as telephone calls, extra refreshments etc, are to be paid directly by yourself.

Date ........................................................................................................................................

Signature ...................................................................................................................................

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