Name (last, first, middle initial):
________________________________________

Affiliation/Institution:
________________________________________________

Address (Street, City, State, Zip, Country):
_______________________________

___________________________________________________________________

___________________________________________________________________

Phone Number: __________________________________

Fax Number: ____________________________________

E-Mail Address:__________________________________

I do plan to attend the TTF Workshop at Burlington, Vermont.

I will be accompanied by a companion.

My check for $90.00 made out to "Transport Task Force" is enclosed. If not enclosed, the registration fee of $90.00 (checks only) will be collected on site.

I would like to make the following presentation at the meeting:

Title:________________________________________________________
(An abstract of the proposed presentation should be enclosed.)

I would prefer and oral presentation

I would prefer a poster

___________________________________________________________________
 
 

TTF WORKSHOP PHONE: (617) 253-5456

c/o Valerie Censabella FAX: (617) 253-0627

MIT Plasma Science and Fusion Center

175 Albany St., NW17-186

Cambridge, MA 02139