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"Space Development: Theory and Practice-2008"
Annual International Workshop and Scientific Conference
July 5 - 15, 2008
Korolev, Moscow region, Russia

Application Form

Please fill out all fields carefully.

Name:
(Last or Family Name, First, Middle)

Date of birth (DD-MM-YY): Sex:

Citizenship:

Country and city of birth:

Passport Number:

Place of Issue:

Date of Issue(DD-MM-YY):

Expiration Date (DD-MM-YY):

Home Address (Zip Code/ Country/ City/ Street/ PO Box/ Apt. #):

Employer:
(if you are a student, identify your school in this field)

Occupation:

Employer's Address (Zip Code/ Country/ City/ Street/ PO Box/ Apt. #):


Telephone(Country Code - Area Code - Number):

Fax(Country Code - Area Code - Number):

E-Mail Address:

How long are you going to stay in Russia?

Please, identify the Russian Consulate you are going to obtain

your visa from :

Please give details of any physical condition which may require
special accommodations (if none please state):


Please list any dietary restrictions which we will need
to accommodate (if none please state):

Date:___________ Signature:________________