Russian Academy of Sciences
Steklov Mathematics Institute
Lomonosov Moscow State University

International Conference
"Gauge Fields. Yesterday, Today, Tomorrow"


Steklov Mathematical Institute, Moscow, Russia,
January 19-24, 2010



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REGISTRATION FORM
Please, fill in the following form. Fields, marked with an asterisk * sign, are obligatory.

The filled registration forms have to get the Organizing Committee before December 1, 2009.

Names as indicated in your passport:
Given name (names):*
Family name:*
 * Male    Female
Citizenship:*
Country:*
Affiliation, position:*

Mailing address:
Zip Code* Country* City*
Street* Building No* Office
Phone number FAX number E-mail*

Date of arrival:* Date of departure:*

Are you going to give a talk?   Yes   No
The title of your talk:
Short abstract of the talk:
Key words:

The number of accompanying persons:
The names of accompanying persons:

Do you need a financial support? Yes    No

Visa Information

Non-residents who need a Russian visa should supply their personal data. Please, also fill up the registration form for every accompanying person.

Passport:  
Number of the passport:
Issue date of the passport:
Exact expiration date:
Warning: Your passport is supposed to be valid not less than 3 months from a date of your departure from Russia. If you come for more than 14 days please send us a pdf file with a copy of the first two pages of your passport.
Date of birth (dd.mm.yy):
Place of birth:

Places in Russia
you are going to visit:
The address of residing in Moscow during visit
(please write "Steklov Mathematical Institute", if you prefer to book your accommodation via the Organizing Committee):

Children younger than 16:
(if they accompany the invited person, don't have their own passports and consequently are indicated in the passport of the invited person. Only the names and the dates of birth of these children in the same format as they are indicated in the corresponding passport; please, mention in whose passport the children are indicated)

Steklov Mathematical Institute

© Steklov Mathematical Institute, 2009