--------------------  REGISTRATION FORM  --------------------

                   The  International Student School

                  "SELECTED TOPICS IN NUCLEAR THEORY"

                   Dubna, Russia, July 20 - 29, 2004

                          REGISTRATION FORM

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

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

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

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

 Phone:.........................   Fax:.............................

 E-mail: ...........................................................

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

 Please, return to:

 E-MAIL: sttnp04@thsun1.jinr.ru

 FAX:   (7-09621) 65084

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