Preliminary conference registration form

Please fill in the following form:

Sex --Select one-- male female

Form of address --Select Your form-- Dr. Prof. Mr. Ms. Other              Fill if other   

First name             Surname
Degree

Position

If you are a Student/ Post-graduate --Select one-- Student Post-graduate
Company or educational institution

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Company or educational institution address:
House number/ P.O.Box   Street
Apt/Suite   City
Postcode/ ZIP code   Country
 
Tel. (+ country code):
Fax  (+ country code) :  
E-mail:

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I am an author
I am a co-author         Title of the paper

I am going to attend the Conference without paper presentation

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I don't mind       I mind
my name, surname, country, company, e-mail and fax number being published in the list of conferees.

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FORM OF PAYMENT

[ by bank transfer]                                       [ by credit card at the registration ]
Please note that the Conference fee of $350 per person will increase to $400 after 26 June 2007.
(Students and post-graduates have a 50 % discount of the Conference fee).

We ask you earnestly to inform CSRI Elektropribor about all changes in your data
E-mail: symptg-smm@eprib.ru