First Name:  
             (please do not include punctuations or accents)
  Last Name: 
             (please do not include punctuations or accents)

Affiliation: 

Mailing Address:
     Line 1: 
     Line 2: 
     Line 3: 
     Line 4: 

  Day Phone:  
        Fax: 
      Email: 


TRAVEL INFORMATION:


  Arrival Date: 

Departure Date: 


Flying into Denver International Airport?   Yes   No

          Will you need a CSU campus parking permit?   Yes   No


WORKING GROUP PREFERENCES:

Please indicate your working group interest (1=primary, 2=secondary, blank=n/a):

 1. Neutrino mass studies (solar neutrinos and double beta decay) 
 2. Neutrino mixing studies (atmospheric and long baseline) 
 3. Dark matter searches and precision radio-assay 
 4. Nucleon decay 
 5. Astrophysics (SN, diffuse SN flux, neutrino astronomy)

6. Other: