REGISTRATION FORM

Registration and Visa Information

Prof. Dr. Mr. Ms. or Surname: Name(s): Date, month and year of birth: Sex: Citizenship: Passport number: Date, month and year of issue: Date, month and year of expiration: Place of work (full name): Position: Home Institute address: Phone (office): FAX: E-mail:

I plan to contribute a paper: YesNo Contribution title:

Abstract:

Itinerary inside Russian Federation: Place of applying for the visa (country and city): Desirable duration of stay in Russian Federation: Preliminary arrival date: Preliminary departure date:

A scanned copy of the first page of your passport should be sent by E-mail as an attached file in jpg format or a copy forwarded by FAX. Please, find the address here.

In case one will apply for the visa not in one's native country it is necessary to submit a fax copy of the document permitting one's staying in that country.
Upon receipt of personal data, International department will arrange all necessary formalities and sends visa reference number to participant with which they should apply to the Russian Consulate for their visas.
In accordance with the JINR Rules and Regulations, your social insurance cover is the responsibility of your employer or of the educational institution at which you are normally enrolled. If you do not have this kind of insurance covering you for Russian Federation, you are under the strict obligation to take the necessary measures to safeguard yourself against the economic consequences of illness, accidents and disability throughout your entire stay at JINR.

Accompanying Person(s) (under 16)

Name(s) and year of birth:

I would like to draw attention of the Local Organizing Committee to the following requirements and/or comments:

Comments: