Fifth ``Rencontres Mathematiques 
      de l'Universite de Rouen''

         Complex Analysis and 
    Partial Differential Equation

      Rouen, June 19-20-21, 2002

____________________________________________________

Name: ___________________________________

Institution: ____________________________

Address: ________________________________

Tel: ____________________________________

Fax: ____________________________________

E-mail: _________________________________


Arrival day: ____________________________

Departure day: __________________________

Do you wish a hotel reservation:

   for   Tuesday June 18th  : Yes   No
   
   for Wednesday June 19th  : Yes   No
   
   for  Thursday June 20th  : Yes   No

   for    Friday June 21th  : Yes   No


       Single  or  Double (shared)

If you plan to stay more in Rouen, do you wish that 
we help you to make a hotel reservation for a day or
more before or after the conference?

____________________________________________________


Please, send your registration form 

by regular mail to
  Rencontres Mathematiques de l'Universite de Rouen
  Laboratoire de Mathematiques raphael Salem
  UMR CNRS 6085
  Universite de Rouen
  76821 Mont Saint Aignan Cedex
  France

or by email to
  Rencontres.Math@univ-rouen.fr

or by fax to
  (33) [0]2 32 10 37 94.