**************** REGISTRATION FORM and VISA INFORMATION **************** International School "HEAVY QUARK PHYSICS" May 27 - June 5, 2002, JINR (Dubna, Russia) REGISTRATION AND VISA APPLICATION FORM Full Name: ........................................................... Institution: ......................................................... Position: ............................................................ Mailing address: ..................................................... Phone (office): ...................................................... FAX: ................................................................. E-mail: .............................................................. I plan to contribute a lecture: Yes / No Contribution title: .................................................... Birthdate: ............................................................. Citizenship: ........................................................... Sex: ................................................................... Passport number: ....................................................... Passport valid until: ................................................... In which town do you intend to get your visa to entry Russia: ........... Itinerary inside Russia: ................................................ Preliminary arrival date: ............................................... Preliminary departure date: ............................................. Accompanying Person(s)(under 18) ........................................ Note: Please, send a copy of your passport by fax to organizers, find the address below. Send this registration form, by e-mail or fax to: S.N. Nedelko (Scientific secretary) Bogoliubov Laboratory of Theoretical Physics Joint Institute for Nuclear Research 141980 Dubna (Moscow region) Russia Email: hq2002@thsun1.jinr.ru FAX: 7-09621-65084