Family name

First name

Sex (f/m)

Position (title)

Organization

Mailing address

City

ZIP-Code

Country

Phone

Fax

E-mail address

Preliminary title of the talk

If you would like to have a visa support

Date of birth

Passport Number

Passport valid until

(year/month/day)

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)