ICGAC-12

XIIth International Conference on Gravitation, Astrophysics and Cosmology

June 28-July 5, 2015, PFUR, Moscow, Russia

Information for getting a VISA (for accompanying persons also):

Full name (as in passport):
Sex:
Marital Status:
Mailing address, phone, FAX, E-mail:
Permanent home address, phone, FAX, E-mail:
Address, phone, FAX, E-mail:
Place of work, address, phone, FAX, E-mail:
Position:
Date of birth:
Country of Citizenship:
Country of Legal Residence:
Country of Birth and place of birth (city):
Previous visits in Russia:
Do you have any health or physical disability? If yes, please explain (please, attach a copy of your Health Certificate):
Dates of arrival and departure:
Place of Visa issue:

A SCANNED copy (300 dpi, grayscale) of your passport page with photo is also required (your passport must be valid 6 months after the intended date of departure from Russian Federation) and should be sent to Dr. Michael Filíchenkov, PFUR database and the scientific secretary of the conference (Dr. Sergey V. Bolokhov).



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