6th International Summer School and Conference

             "Let's Face Chaos through Nonlinear Dynamics"

                     26 June - 10 July 2005 

-----   Dedicated to the 75th Birthday of Professor Siegfried Grossmann  -----

     CAMTP - Center for Applied Mathematics and Theoretical Physics
              University of Maribor, Maribor, Slovenia



                    ARRIVAL AND RESERVATION FORM

     Please fill in this form and send it to Prof. Marko Robnik
     at the e-mail address:    chaos@uni-mb.si


NAME:

SURNAME:

SEX: female/male (delete inappropriate)

TITLE: Mr. Mrs. Dr. Prof. Acad. Sir (delete inappropriate)

STATUS: undergraduate student, graduate (PhD) student, postdoc, junior
researcher, senior researcher, Professor (delete inappropriate)

E-MAIL ADDRESS:

CITIZENSHIP:

COUNTRY AND TOWN OF CURRENT RESIDENCE:

DO YOU NEED HELP IN VISA INFORMATION: Yes/No

FULL POSTAL ADDRESS (Street + No, Area Code, Town, State):

TELEPHONE:

TELEFAX:

THE DATE OF ARRIVAL (normally this should be Sunday 26 June 2005):

I shall arrive by (describe)

THE DATE OF DEPARTURE (normally this should be Sunday 10 July 2005):

I shall depart by (describe)


ACCOMMODATION RESERVATION (Please delete inapropriate options):

Option 1:

I wish to be accommodated at the Student Residence Dijaski Dom DRAVA,
Smetanova ulica 67, SI-2000 Maribor, Telephone +(386) (2) 2348 150,
2348 154, Telefax +(386) (2) 2348 170.


Option 2:

I wish to be accommodated in the Hotel PIRAMIDA, Heroja
Slandra 10, SI-2000 Maribor, Telephone +(386) (2) 2344 400, 
Telefax +(386) (2) 2344 360, and shall pay extra expenses
of 30.-EUR per day upon arrival.


Option 3:

I need some special arrangements, also including accompanying
persons as described below and ask for your advise and information: