PRIA-7-2004 Registration form

русская версия

Registration form

Title:

First Name, Family Name:

Position:

Institution/Company:

Company Mailing Address:

City:

Phone:

Country:

Fax:

Postcode:

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.

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:

All the information provided is correct: yes no