International Research Conference on Nuclear Physics
High Spin Physics 2001
February 6-10, 2001, Warsaw, Poland
Please charge the amount of the conference fee to my Credit Card:
| Name: | ___________________________________________ |
| Address:* | ___________________________________________ |
| Credit Card type: | ___________________________________________ |
| Credit Card number: | ___________________________________________ |
| Credit Card expiration date: | ___________________________________________ |
| Amount (specify dollars or zlotys): | ___________________________________________ |
| Date: | ___________________________________________ |
| Signature: | ___________________________________________ |
*Must match the address for which the Credit Card has been issued.