REGISTRATION FORM

NAME:..............................................................

FIRST NAME: .......................................................

I intend to participate in the Conference (yes, no):...............

I would like to give a talk on: ...................................

...................................................................

MAILING ADDRESS:...................................................

PHONE:..................... FAX:...................................

E-MAIL: ...........................................................

CITIZENSHIP........................................................

DATE OF BIRTH......................................................

PASSPORT NUMBER....................................................

PASSPORT VALIDITY..................................................

ARRIVAL/DEPARTURE DATES............................................

RUSSIAN CONSULATE/EMBASSY APPLIED FOR VISA.........................

...................................................................

ITINERARY INSIDE RUSSIA............................................


Please, return to:

Dr. A. Shanenko
E-MAIL: shanenko@thsun1.jinr.ru