European Rocket & Balloon Programmes and Related Research

Online Registration

To be completed before 30 April 2005

Note: For Credit Card payment use the Credit Card Payment PDF form.

Fill the form below and click 'Send' or alternatively, print this form and return to 'Andøya Rocket Range, c/o Mrs. Siri Magnussen', Fax: +47 7614 4401

Contact Details

Family name:	First name:	Title:
Organisation/Company:
Department:
Address line1:
Address line2:
Zip code:	City:
Country:
Telephone:	Telefax:
e-mail:
Special requirements for presentation:

Registration

Wishes to register for the 17 th ESA Symposium on European Rocket and Balloon Programmes and Related Research:

Regular participant: NOK 2300,-

Student participant: NOK 1150,-

Accompanying person: NOK 1050,-

Please note that for registrations received after 30 April 2005 the fee will be NOK 2800,- for all participants (incl. students).

Excursion/Dinner

Visit to Stavern by steam boat and bus or

City walk and bus trip to Folehavna

No Excursion

I will participate in the closing dinner with persons

Special requirements for meals (vegetarian, etc.)

Hotel Reservation:

I wish to reserve a room in the Rica Park Hotel (please tick the appropriate box)

None

Single room (shower/toilet) at NOK 725,- per room per night including breakfast

Double room (shower/toilet) at NOK 1025,- per room per night including breakfast

Student room 35% discount of standard single room rate including breakfast

These rates are valid for arrival on 29 May and departure on 3 June 2005 .
Please note that you will be charged 100% of the room rate for the first night of your reservation in case of no-show.

Date of arrival:		dd/mm/yy
Date of departure:		dd/mm/yy
Expected arrival time:

Accompanying person(s): Name:

To be completed before 30 April 2005

Payment

Please indicate which method of payment you will use:

Note: For Credit Card payment use the Credit Card Payment PDF form.

Bank transfer to account no: 8982.09.00716 , Nordlandsbanken ASA, P.O. Box 84, N-8483 Andenes, Norway mentioning your name and affiliation. Swift address: NOBANO22, IBAN: NO3989820900716, in favour of 17. ESA Symposium

Bank cheque

On-site payment (cash or credit card) upon registration (NOK 2800,- or NOK 3000,-)

Registration fees will be refunded only if cancellation is received by the ESA/EASP office before 30 April 2005