Документ взят из кэша поисковой машины. Адрес оригинального документа : http://ysc.sm.bmstu.ru/eng/sdtp/SDTP2012_application_form.doc Дата изменения: Mon Mar 12 12:07:01 2012 Дата индексирования: Mon Oct 1 19:27:24 2012 Кодировка: Поисковые слова: южная атлантическая аномалия

"Space Development: Theory and Practice-2012"
Annual International Workshop and Scientific Conference
July 3 - 14, 2012
Moscow, 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:________________