4th INTERNATIONAL CONFERENCE ON PHYSICS OF 
LIGHT-MATTER COUPLING IN NANOSTRUCTURES (PLMCN4)
June 29 - July 3,  2004, 	St. Petersburg,  RUSSIA  
Registration&Accommodation Form
Participant
Family Name ______________________
First Name ________________________________ Second Name _______________________
(as stated in your passport)

Title        Prof     Dr     Mr     Mrs     Ms
(double-click on the checkbox to fill and choose “checked” or “not checked” as Default Value)

Affiliation _______________________________________________________
Position________________________

Sex            Female     Male 

Mailing Address _______________________________________________________________
City __________________ZIP code _____________________Country____________________
Phone __________________________________  Fax _________________________________
E-mail ______________________________

Citizenship _________________________
Birth Date (dd.mm.yyyy) ___________________ Birth Place ________________________
Passport Number _______________________
Passport Issue Date (dd.mm.yyyy) _____________________
Passport Expire Date (dd.mm.yyyy) ____________________

 I have submitted a paper 
 I am going to attend the Conference without a paper 

 Send me the Invoice for Registration Fee payment

	 Regular Fee           Student Fee           Accompany Person Fee

Accompanying person 
(please copy this form on a separate sheet if you are accompanied by more than one person)
Family Name ______________________
First Name ________________________________ Second Name _______________________
(as stated in the passport)
Sex            Female     Male 
Citizenship _________________________
Birth Date (dd.mm.yyyy) ___________________ Birth Place ________________________
Passport Number _______________________
Passport Issue Date (dd.mm.yyyy) _____________________
Passport Expire Date (dd.mm.yyyy) ____________________

If you need a visa, please, fill-in the fields with RED titles

Optional Social Program  
 is provided for additional costs paid at the Registration desk. The average prices of not more than 20 EUR per item per person will be refined to the beginning of the Conference
We are planning to attend							           Number of
persons
    Excursion to Peterhof on Wednesday Morning, June 30			____
    Excursion to Hermitage with a
   with	  English,      French,      German,      Japanese    guide
   on	  July 1          July 3							____

Accommodation 

No hotel prepayment is necessary

I would like the Organizing Committee to book for me a room in the hotel “Moscow”

Room
category	Single,
EUR	Double,
  EUR	
A	      120	         160	
B	      110	         140	

Arrival date (dd.mm.yy)_________________     Departure date (dd.mm.yy)_______________

Number of nights ________

I would like to share the room with __________________________________

Please return this form at your earliest convenience or by April 9th 
 to the Organizing Committee via E-mail: plmcn4@mail.ioffe.ru or fax: +7-812-247-3620/1017.  Thank you!