| I am interested in being involved in PRIA-7-2004. |
| Title ................................................................................................................................ |
| First Name .................................................. |
Family Name ............................................... | |
| Position ........................................................................................................................... |
| Institution/Company ......................................................................................................... |
| Company Mailing Address ................................................................................................. |
| City ..................................... |
Country ............................... |
Postcode .............................. | |
| Phone .................................. |
Fax ..................................... |
E-mail .................................. | |
| I am going to submit a paper: |
| number of topic of interest ............................................................................................... |
| title "..............................................................................................................................." |
| I am going to present a tutorial: |
| title "..............................................................................................................................." |
| I am going to demonstrate an exhibit "..............................................................................." |
| Registration fee (please, choose): |
| |
before 1 Aug, 2004 |
after 1 Aug, 2004 |
| Non-IAPR Members |
550 euro |
|
650 euro |
|
| IAPR Members |
450 euro |
|
550 euro |
|
| Students* |
350 euro |
|
450 euro |
|
| Exhibition Fee |
350 euro |
|
450 euro |
| |
| |
Registration fee covers entrance to the conference, one copy of the Proceedings, visa support and social program (conference dinner and two excursions). |
| |
| * Please, note that the conference dinner is not included into student conference fee. |
| Date ......................................................... |
Signature ................................................... | |
| |
| Additional information required for visa support: |
| Date of Birth (dd.mm.yyyy) ............... |
Gender ..................... |
Citizenship .......................... | |
| Passport Number ......................................... |
Date of Expiry ............................................. | |
| Place of Passport Issue (country, city, passport issue organization) ...................................... |
| Date of Passport Issue (dd.mm.yyyy) ................................................................................ |
| Date of Entrance to Russia ........................... |
Date of Departure ....................................... | |
| Cities you are going to visit ............................................................................................... |
| City, where you will apply to the Russian Consulate for visa ................................................. |
| |
For visa support you should send the scanned version of your passport to pria2004@ccas.ru, before 1.08.2004. |
| |
| All the information provided is correct (signature) ................... |
(date) ............................... |
| | |
