Registration Form

Please, fill in and send this form as early as possible (in English).

Participant(s):

Family Name

First Name(s)

Degree, title

Prof Dr Mr Mrs Ms

Affiliation

Mailing Address

City and Postal Code

Country

Phone

Fax

E-mail

I shall be accompanied by...person(s)

Who of authors of the paper will be the speaker

Will you participate in the Symposium personally

Yes No

Time of arrival in St. Petersburg

Time of leaving St. Petersburg

Room in the hotel you need

single double one bed in a double room

Additional Information or request (if necessary)

Accompanying person(s):

Family Name

First Name(s)

Sex:

Female Male

Time of arrival in St. Petersburg