Registration Form

JTI Workshop on Dynamics of Symmetry Breaking,      

Argonne National Laboratory, IL

April 13-17, 2009

It is anticipated that there will be no registration fee for attendees. Please send an e-mail to one of the organizers, Hovhannes Grigoryan in which include the information noted in BOLD type below. It is very important to send citizenship information ASAP, so that a request for onsite approval can be made. In the case of non-US citizens, the process can take anywhere from one week to a month or more.

Your Full Name:

Your Citizenship:

[NOTE: If not a US citizen, also state your date of birth and place of birth (city and country), and whether or not you are a legal permanent US resident (LPR). If you are an LPR, please provide LPR number and expiration date, as well as your passport number, issuing country, and expiration date. If not an LPR, provide your passport number, issuing country, and expiration date, as well as your visa type, number, and expiration date. If no visa information is available, you must provide number and expiration date from Federal backup form of ID, i.e. I-94, I-727, I-20. All those holding J-1 visas must also provide DS2019 info.]

[Note: Any non-US (adult) citizen that expects to accompany a Workshop attendee onsite must also, at this time, provide the above information.]

Each attending, non-US citizen will be advised of what type of original, valid, Federal ID must be provided upon Argonne arrival.

Permanent (employing) institution:

Arrival date and time:

Departure date and time:

Place of lodging:

Talk: yes___ no___   If yes, title:

Car available: yes___ no___   If yes, are you agreeable to car pooling? yes___ no___