PERSONAL INFORMATION

Name as it should appear on name badge:

  First:    Last: 

  Affiliation: 

Email: 


REGISTRATION FEE*

Registration:               Cost if received on or          Cost if received
                            before November 10              after November 10

(Please check one:)          $40                          $50

Includes coffee breaks and both lunches.


BANQUET TICKETS*

Number:                      x $50

The banquet and Saturday lunch will both be buffets, with choices of entreé 
including one vegetarian (and similarly for the Sunday bag lunch). 


HOTEL*

Nights:    Nov. 30       Dec. 1       Dec. 2      Number (0-3):  x $130

Room:      Single        Double

Daily transportation from hotel to campus needed:  Yes    No

The Conference hotel is:

Holiday Inn Express
3131 Nesconset Hgwy. (Rte. 347)
Centereach
631-471-8000
(fax 631-471-8623)

Availability of rooms is guaranteed for registration before Nov. 23.
Payment (check or cash) must be through the Conference to avoid taxes 
of over $30/night.

Bed and breakfast is also available; you may need to provide 
your own transportation.  (Port Jeff. locations are within 5 mis.)


TOTAL

Sum above amounts (registration, banquet, hotel):     Total:  $ 

Make checks or money orders, in U.S. dollars,
payable to "Stony Brook Foundation Acct. # 284100."
Write "SG@25" on the check, and mail to:

   Supergravity at 25
   C.N. Yang Inst. for Theoretical Physics
   SUNY, Stony Brook, NY 11794-3840
   USA

   Attn: Doreen Matesich

*Support will be available for junior participants to help with local expenses;
please e-mail us at sg25@insti.physics.sunysb.edu.