TOPOLOGY AND DYNAMICS: ROKHLIN MEMORIAL
19-25 August, 1999

Registration Form

Family name (as in passport):

First name(s) (as in passport):

Affiliation:

Position:

Address (official)

 

 Street address:

 City:

 Postal code:

 Country:

Fax (official):

Phone (official):

e-mail:

I need a hotel:

yes no

From:

Till:

Please, give 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 appartment:
number of persons:

I intend to give a talk:

yes no

   

Title:

   

I need a Russian visa:

yes no
   

If you need a visa, please, fill in the following VISA FORM:
   

Date of arrival:

Date of departure:

Citizenship:

Passport number:

Passport expiration date:

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

Date of birth:

FAX number to send the invitation to:
Mailing address to send the invitation to:
   
IMPORTANT:You need to send a copy of your passport (the pages containing your name, passport number and passport expiration date) by fax to

 7 812 234 5819 or 7 812 310 5377 for Elena Novikova

Do likewise with the passports of all accompanying persons.

   

I would like to come with accompanying person(s):

yes no

   
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).

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

   

 

Fill in the above APPLICATION FORM or send via E-Mail or FAX to:

FAX: +7 812 234 5819 or
+7 812 310 5377

E-mail: rokhlin@euler.pdmi.ras.ru