FIRST NAME(S) and SURNAME: __________________________________________

TITLE:

MR

MRS

DR

PROF

MAILING ADDRESS: _____________________________________________________

________________________________________________________________________

Phone:	Fax:
Telex:	E-mail:

Citizenship:

Passport number and date of expiry:

Day, month and year of birth

I am planning to attend the conference in	Moscow []	Dubna []	Kyiv []
I am planning to submit a contribution:	Yes []	Maybe []	No []

Preliminary title of the contribution: ____________________________________

________________________________________________________________________

Please choose one of the following topics

	Mathematics and nonlinear mechanics	[]
	Quantum field theory	[]
	Elementary particles	[]
	Statistical physics and kinetics	[]
	Nuclear physics	[]

Deadline for application: May 1, 1999.

This form should be directed to:

A.N. Sissakian,
JINR, Joliot-Curie 6, 141980 Dubna, Moscow Region, Russia.

E-mail:bog1999@thsun1.jinr.ru
Fax: (7 096 21) 65 599