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\title{Classical Chaos and its Quantum Manifestations, Toulouse, July 16th-18th
1998}
\author{ Universit\'e Paul Sabatier/ C.N.R.S. Toulouse
  \thanks {Organizing committee: J. Bellissard, D.
 Shepelyansky }\\
Universit\'e Paul Sabatier, Toulouse 
\thanks {118, route de Narbonne, F-31062, Toulouse Cedex, France; e-mail:
sylvia@irsamc2.ups-tlse.fr}
}
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\begin{center}
{\Huge Registration Form}
\end{center}

\vspace{.2cm}

{\Large 
\noindent Name:  \hspace{6cm} First Name:

\vspace{.2cm}

\noindent E-Mail :  \hspace{4cm} Tel:\hspace{3cm} Fax : \hspace{3cm}

\vspace{.2cm}

\noindent Address :

\vspace{1cm}

\noindent Arrival time:

\vspace{.2cm}

\noindent Departure time:

\vspace{.2cm}

\noindent Hotel reservation: \hspace{1cm} YES $\Box$ \hspace{1cm} NO $\Box$

\vspace{.2cm}

\noindent number of nights:

\vspace{.2cm}

\noindent I want a \hspace{1cm}  single room $\Box$ \hspace{1cm} double room
$\Box$

\vspace{.2cm}

\noindent with \hspace{1cm} bath $\Box$ \hspace{1cm} shower $\Box$ \hspace{1cm} TV
$\Box$ 

\noindent Approximate Price : \hspace{1cm} 160FF $\Box$, \hspace{1cm}200FF
$\Box$, \hspace{1cm} 250FF $\Box$, 

\noindent \hspace{6,5cm} More $\Box$

\vspace{.2cm}

\noindent I want to present a poster \hspace{1cm} YES $\Box$ \hspace{1cm} NO
$\Box$

\vspace{.2cm}
\noindent Title of talk/poster:

\vspace{.2cm}

\noindent Registration for banquet (Friday July 17th, evening):


\hspace{1cm} YES $\Box$ \hspace{1cm} NO $\Box$ \hspace{1cm} Number of persons:
$\Box$}

\vspace{.2cm}

\noindent {\small  Reply to Sylvia Scaldaferro, by e-mail or fax 
(before April 15th  1998)

\noindent Laboratoire de Physique
Quantique, Universit\'e Paul Sabatier, 

\noindent 118, route de Narbonne, 31062 Toulouse
Cedex, 

\noindent e-mail: sylvia@irsamc2.ups-tlse.fr, 

\noindent Tel: +33 5 61 55 68 34, Fax: +33 5 61 55 60 65}

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