First Name :  _______________ Surname : ________________

Media : ________________________________________________

Address : ______________________________________________

Tel:  ___________________  Fax : _______________________

Mobile : ______________ E-mail : _______________________


(  )  	Germany
Location : Robert Bosch Str. 5, Darmstadt, Germany
Opening hours : 07:00 – 11:00
Contact : Jocelyne Landeau-Constantin, 
Tel : +49(0)6151.90.2696  
Fax : +49(0).6151.90.2961	

(  )	France
Location : ESA HQ – Room 137 
Address : 8/10, rue Mario Nikis – Paris 15, France
Opening hours: 07:45 – 10:00	
Contact: Anne-Marie Rémondin, 
Tel: +33(0)1.53.69.7155 
Fax : +33(0)1.53.69.7690 

(  ) 	The Netherlands
Location : ESTEC, the Wintergarden
Address : Keplerlaan 1, Noordwijk Netherlands
Opening hours: 07:45 – 10:00	
Contact :  Rosita Suenson, 
Tel: +31.71.565.3009 
Fax : +31 71 565 5728


(  )	Italy
Location : ESA/ESRIN, Ada Byron Room
Address: Via Galileo Galilei, Frascati (Rome), Italy
Opening hours: 07:45 – 10:00
Contact: Franca Morgia : 
Tel: +39.06.941.80.951 
Fax +39 06 94180 952