**************** REGISTRATION FORM and VISA INFORMATION ****************



                 Helmholtz International Summer School

                       "HEAVY QUARK PHYSICS"

               June 6 - 16, 2005, 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: hq2005@theor.jinr.ru

FAX:   7-09621-65084