REGISTRATION FORM

Please, fill in with BLOCK LETTERS and send to the address:

Udmurt State University, International Relation Department
Russia, 426034, Izhevsk, Universitetskaya Str. 1
Phone: 7 (3412) 78-15-92, Fax: 7 (3412) 78-58-66
E-mail: inter@uni.udm.ru

PARTICIPANT DATA

First Name

Last Name

Sex: ÿ Male ÿ Fem.

Address (check one) ÿ Place of employment E-mail

ÿ Home

Postal code and city

Country Telephone:

Fax:

LECTURING

Title of the lecture

 

ÿ Lecture at a reports section

ÿ Lecture at the symposium

Equipment required

ACCOMMODATION

ÿ А Hotel Single room 10-35$

ÿ B Hotel Double room 15-55$

Dietary restrictions:

Approx. Booking dates from _____________ till _________May_2001г.

Additional information________________________________________________________________

 

Date__ _______________________Signature__________________________