WORKSHOP ON COMPUTATIONAL PHYSICS 
               
         DEDICATED TO THE MEMORY OF STANISLAV MERKURIEV
                        
                        Registration Form

1   Family name:

2   First name(s):

3   Citizenship:

4   Country of permanent residence:

5   Degree, title(s):

6   Affiliation:

7   Position:

8   Mailing address:

9   e-mail:

10  Phone(s):

11   Fax:


 If you need visa fill in the following fields as well:

12   Date of birth:

13   Place of birth:

14   Passport number:

15   Passport date of issue:

16   Passport date of expiry:

17   City (with a Russian  Consulate) where you will apply for a visa:

18   FAX number to send the invitation to:

19   Mailing address to send the invitation to:

20   I would like to visit the cities:

 

IMPORTANT: 
please fax to: + 7 (812) 234 58 19 ( for Elena Novikova) 
a copy of two adjacent pages of your passport which contain your photo, 
passport number and expiration date  

Do likewise with the passports of all accompanying persons 

I would like to come  with accompanying person(s):   yes  no

 Their names: 

 If "yes", please fill in the same fields 1-20 for every of them 
 (please DO NOT omit affiliation, position, address and fax of the institution 
  FOR EMPLOYED and FOR STUDENTS or PUPILS) 

IMPORTANT: 
Please, check that your medical insurance is valid in Russia.

I need a hotel:                   yes  no

Date of arrival:

Date of departure:

If possible, please provide the details about the type of room you wish 
and the persons you wish to share the room with:

number of rooms:

shared with:

price per apartment:

number of persons:

  
To submit the form, please e-mail it to: admin@euler.pdmi.ras.ru or novikova@pdmi.ras.ru