IMPORTANT: together with this application, fax a copy of your passport 
main page at +7-3854-43-53-00 (with a note: for Alexander Kazantsev).
Alternatively, you may send a pdf copy of your passport by e-mail to biisk2011@gmail.com together with this inquiry.

Note: all fields are obligatory

First name (full):
Last name:
Title of your talk at the conference:
Date of birth:
Gender:
Citizenship (list all of them if you have a few):
Country of birth:
Place of birth:
Country of permanent residence:
Region (state) of residence in the country of permanent residence:
Place of visa issuing (Country, city):
Place of work:
Address of your place of work:
Position:

Passport information (please be careful and don’t make a typo!)

Series and number of your passport:
Date of issue:
Valid till:

Date of arrival:
Date of departure:
Your mail address (where you want your official invitation to arrive):

If you want your kids to travel with you, please provide us with the following information (for each kid separately):
First name (full):
Last name:
Date of birth:
Gender:
Citizenship (list all of them if there are a few):

For the accompanying person(s), provide us with the same inquiry.