Registration Form for visa support

The V th Vereshchagin Baikal Conference
October 4 - 9, 2010

PLEASE FILL IN THE QUESTIONNAIRE AND SEND IT WITH SCANNED COPY OF YOUR PASSPORT  TO: Alexey Gurulev gurulev@lin.irk.ru

PARTICIPANT:

Name (Mr / Ms / Dr / Prof):…………………………………………………………………..
First name:……………………………………………………………………………………. 
Birthdate……………………………………………………………………………………….
Country of birth, place of birth……………………………………………………………. 
Citizenship (second citizenship or more if available)…………………………………
Passport number………………………………………….date of issue:……………….. date of expiry……………………………………..
(scanned copy of pages of your passport where they are indicated)
Name of the region where you live now (Prefecture or Canton, or Province, or State and so on...  as is customary in your country)……………………………………
……………………………………………………………………………………………………
Country of permanent residence…………………………………………………………..
Name of your organization………………………………………………………………….
……………………………………………………………………………………………………
 its mail (full) address, telephone, fax ………………..………………………………….
……………………………………………………………………………………………………
Your position …………………………………………………………………………………
Planned visiting period in Russia and Irkutsk…………………………………………..
Cities you plan to visit (transit) on the territory of Russia (not more than 6)……..
……………………………………………………………………………………………………
Where you are going to apply for visa (the city where the Russian Consulate is available)……………………………………………………………………………………….