TITLE: Mr Mrs Dr Prof

MAILING ADDRESS:

Phone: Fax:
Telex: E-mail:

Citizenship:

Passport number: Date of expiry:

Day, month and year of birth:

I am planning to attend the conference in: Moscow Dubna Kyiv

I am planning to submit a contribution: Yes Maybe No

Preliminary title of the contribution:

Please choose one of the following topics: Mathematics and nonlinear mechanics Quantum field theory Elementary particles Statistical physics and kinetics Nuclear physics