H-mode Workshop Registration

* = mandatory fields

Personal Data

*	Did you submit an abstract?	yes no
	If yes, please indicate your code here

*	Title	Prof. Dr. Mrs. Ms. Mr.

*	Surname

*	First Name

*	Institution/Affiliation

*	E-mail

*	Address

*	Postal Code

*	City

*	Country

Data for receipt of registration and invoice

*	Are these data the same as above?	yes no

	If no, please fill in the following fields:

	Name

	Address

	Postal Code

	City

	Country

Fee / Payment

The conference fee is 120 Euro and contains refreshment during coffee breaks as well as the conference dinner on Tuesday evening.
Please pay an extra 50 Euro for the conference dinner for each accompanying person.

Accompanying persons (dinner a 50 Euro)

*	I will pay via	Bank transfer (120 Euro + 50 Euro conference dinner for each accompanying person) Please make sure that all charges are at the expense of the ordering customer.

		Credit Card (120 Euro + 50 Euro conference dinner for each accompanying person) Payment per Credit Card causes additional charges of 5 Euro.

Further Information

*	I intend to write a publication for the planned Nuclear Fusion special issue	yes no

*	I require a letter of invitation for my visa application	yes no
	If yes, please fill all the following fields:

	Nationality
	Date of birth	Year Month Day
	Sex	m f
	Place of birth
	Country of birth
	Passport number
	Date of issue	Year Month Day
	Date of expiry	Year Month Day
	Issuing Authority

This registration system has been created by S. Greber and W. Grieger, GWDG, Göttingen.