Use Latin characters!           Last name:
First name:
Middle names:
The names should be typed exactly as in your passport.
No abbreviations are valid. This is important for visa application.

Title (Prof/Dr/Mr/Mrs):
Sex: Male  / Female 
Institution: 
Position in home institute:

Exact postal address of the institution (affiliation)
to which the original invitation letter will be sent:

Phone (cell phone, if possible): 
Fax (office):
E-mail:
List of recent publications but no more than five:

Name and e-mail address of a senior scientist able 
to give a recommendation:

I need financial support:
travel 
local 
I need an entry visa

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Date (dd/mm/yy) and place of birth:
Citizenship: 
Residence (country):
Passport number:
Date, month and year of issue:
Date, month and year of expiration:
City of the Russian Consulate or Embassy where
the visa application is to be submitted in your country:

Itinerary inside Russia:
Preliminary arrival date:
Preliminary departure date:
PLEASE, CHECK YOUR DATA BEFORE SUBMITTING.
BE SURE YOUR E-MAIL IS TYPED CORRECTLY.
The same application form should be filled for the accompanying persons if any.
In addition, a copy of the passport page (with a photo) should be sent by Fax or E-mail as a jpeg format (prefered) to Dr.. Irina Pirozhenko: