14th INTERNATIONAL CONFERENCE ON PHYSICS IN COLLISION

Tallahassee Florida June 15-17, 1994

Last Name ...................... First Name .................... Mid.In. ......

Institution ..................................................................

Mailing address:................................................................

.......................................................................

Phone: ......................... Fax: ..............................

E-Mail: [] Internet [] Bitnet (check one) ............................

Arrival date:.................Departure date:...........................

Accompanied by:.........................................................

The conference fee of $300.-- ($330 after April 15) will be paid:

[] advance payment by [] check or [] credit card

[] payment at arrival

(Make check - made out in U.S.Dollars - payable to Florida State University)

Payment by credit card:

[] Visa [] MasterCard/Eurocard

Acct #: .............................. Exp. Date: ............

Name as it appears on card:.....................

Signature: .....................................

Complete this form (please print) and return it to:

PHYSCOLL94

Physics Department

Florida State University

Tallahassee, Florida 32306-3016, USA

FAX: 904-644-6735

E-mail: physcoll94@fsuhep.physics.fsu.edu

Program # 1906194