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{\large  ${11}^{\rm th}$ INTERNATIONAL COLLOQUIUM}

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{\large \bf QUANTUM GROUPS and INTEGRABLE SYSTEMS}

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{\bf Prague, 20\,--\,22 June 2002}
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{\Large\bf APPLICATION FORM}
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\noindent
SURNAME:
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{\small (Block letters please)}\\
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FIRST NAME(S):
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MAILING ADDRESS:
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Phone:
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Fax:
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E-mail:
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I PLAN TO ATTEND THE CONFERENCE: \ (Yes, \ Maybe)\\
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I PLAN TO SUBMIT A CONTRIBUTION: \ (Yes, \ Maybe, \ No)\\
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Preliminary title of the contribution:
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I prefer to live in: \ (Dormitory, \ Hotel)\\
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Please, return this form before {\bf 31 March 2002} to:\\
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Dr. \v{C}estm\'{\i}r Burd\'{\i}k\\
Department of Mathematics\\
Faculty of Nuclear Sciences and Physical Engineering\\
Trojanova 13,  120 00 Prague 2\\
Czech Republic\\
Phone: + 420(2) 24358549
\hskip1cm Fax: + 420(2) 24918643 \\
\hskip1cm {\bf E-mail:}  burdik@siduri.fjfi.cvut.cz
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PLEASE, PROVIDE COPIES OF THIS FORM TO INTERESTED COLLEAGUES

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