Annual International Conference

                        "DAYS on DIFFRACTION"

                           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   Sex:

15   Passport number:

16   Passport date of issue:

17   Passport date of expiry:

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

19   FAX number to send the invitation to:

20   Mailing address to send the invitation to:

21   I would like to visit the cities:



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