Документ взят из кэша поисковой машины. Адрес оригинального документа : http://ysc.sm.bmstu.ru/eng/sdtp/SDTP2009_application_form.doc Дата изменения: Mon Feb 16 19:43:59 2009 Дата индексирования: Mon Oct 1 19:26:07 2012 Кодировка: Поисковые слова: heart nebula

"Space Development: Theory and Practice-2009"
Annual International Workshop and Scientific Conference
July 4 - 14, 2009
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:________________