|
|
 |
International Conference on Heterocyclic Chemistry,
in Honor of the late Professor A.N. Kost's 90th Anniversary
Moscow, 17 - 21 October 2005
Russian Visa
|
|
Please fill in the registration form for the visa and send it to us by e-mail.
| 1. |
Surname |
| 2. |
First, Middle Name(s) |
| 3. |
Date of birth (day, month, year) |
| 4. |
Sex |
| 5. |
Citizenship |
| 6. |
State of birth |
| 7. |
Exact place of birth |
| 8. |
State of permanent place of residence |
| 9. |
Region of permanent place of residence |
| 10. |
Country and city where you intend to obtain the visa in Russian Consulate |
| 11. |
Employer: full name of organization, firm |
| 12. |
Employer's full address (zip code country, city, street, building №) |
| 13. |
Current occupation |
| 14. |
A copy of your passport with the following data: Name and surname, Date of birth, Sex, Citizenship, Passport number, Date of issue, Expiration date |
| 15. |
Dates and duration of planned stay in Russia |
| 16. |
Telephone |
| 17. |
Fax |
| 18. |
Cities which you intend to visit in Russia. |
|
|