-------------------- 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 --------------------------------------------------------------------