Registration Form
Family name:
First name:
Sex (f/m):
Position (title):
Organization:
Mailing address:
City:
Code:
Country:
Phone:
Fax:
E-mail address:
Preliminary title of the talk:
If you would like to have a visa support
please indicate:
Date of birth:
Passport Number:
Passport valid until (day/month/year):
Citizenship:
Location of the Ukrainian Consulate
to which you will apply for visa
(town, country)
If you need visa support
beyond the Conference program,
give a list of FSU countries
and cities you plan to visit
I need room reservation (yes/no):
Approximate date of arrival if known:
Approximate date of departure if known:
Accompanying persons (yes/no):
(if yes, please fill the registration form
for accompanying persons)
