Workshop on Differential Equations dedicated to the memory of Vladimir Lazutkin

St. - Petersburg Department of Steklov Mathematical Institute
August, 18 - 20, 2002


REGISTRATION

The form below includes three section: Registration, Accomodation and Visa application. Please fill in all entries of the Registration section. Fields of Accomodation and Visa application sections may be left blank, dependently on your demand (Cf. information for participants).
    Registration
    Family Name
    First and other names
    Title
    Affilation
    E-mail
    I intend to submit a paperYes No
    Street address
    City
    Country
    ZIP/Postal code
    Fax
    Phone
    Are you sure about participation? Yes
    No, I shall send confirmation e-mail
    Visa application
    Important! You need to send a copy of your passport (as usual, this means "a copy of two adjacent pages one of which contains your photo") by fax to
    +7 812 234 58 19 for Elena Novikova
    Do likewise with the passports of all accompanying persons.
    I need Russian visaYes No
    Date of birth
    Place of birth
    SexMale Female
    Citizenship
    Passport number
    Passport expiration date
    City (with a Russian Consulate)
    where you will aply
    for a visa
    Date of arrival
    Date of departure
    FAX number to send
    the invitation to
    Mailing address to send the invitation to
    I would like to come with accompanying person(s)Yes No
    Important! If "yes", please, make a separate registration and visa form for each accompanying person: fill in the same fields for everyone. Do not omit affiliation, position, address and fax of the institution for employed and for students or pupils.
    Names of accompanying person(s)
    Accomodation
    I need a hotelYes No
    Date of arrival
    Date of departure
    Number of rooms1 2 3
    Shared with
    Desirable price per a day20$ US 40$ US 20$ US 60$ US

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St.-Petersburg, 2002.