-->

Annual International Conference
"DAYS on DIFFRACTION" 

Registration Form

Anti-spam provision:  please retype the word on picture (case insensitive)      

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: Male      Female:
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: Click on arrow and choose from the list
shared with:
price per apartment:
number of persons: Click on arrow and choose from the list

 

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

DD-08 home-page