************************  REGISTRATION FORM ***********************************

                 The  International Workshop

    "HADRONIC ATOMS AND POSITRONIUM IN THE STANDARD MODEL"

           May 26-31, 1998, JINR (Dubna, Russia)


                      REGISTRATION FORM

NAME:..............................................................

FIRST NAME: .......................................................

I intend to participate in the Conference (yes, no):...............

I would like to give a talk on: ...................................

...................................................................

MAILING ADDRESS:...................................................

PHONE:..................... FAX:...................................

E-MAIL: ...........................................................

CITIZENSHIP........................................................

DATE OF BIRTH......................................................

PASSPORT NUMBER....................................................

PASSPORT VALIDITY..................................................

ARRIVAL/DEPARTURE DATES............................................

RUSSIAN CONSULATE/EMBASSY APPLIED FOR VISA.........................

...................................................................

ITINERARY INSIDE RUSSIA............................................


Please, return in duplicate to:


Dr. A. Rusetsky
E-MAIL: Rusetsky@thsun1.jinr.dubna.su
TEL:   (7-09621) 63143
FAX:   (7-09621) 65084

and

N. Dokalenko
E-MAIL: Natasha@cv.jinr.ru
TEL:   (7-09621) 65011
FAX:   (7-09621) 65599, (7-09621) 65891

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