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{\bf Visa Form\\}
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{\bf The VIII-th International Conference\\
"SOLITONS, COLLAPSES AND TURBULENCE:\\
Achievements, Developments and Perspectives"\\
Chernogolvka, Moscow region, RUSSIA\\
May 21-25, 2017}

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\centerline {\bf VISA FORM}

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\begin{tabular}{lll}
1.  First Name: ------------------------------------------------------- \\ \\
2.  Family Name: ------------------------------------------------------ \\ \\
3.  Date of Birth: DD/MM/YEAR ----------------------------------------- \\ \\
4.  Citizenship:------------------------------------------------------- \\ \\
5.  Born in (country, place):------------------------------------------ \\ \\
6.  Permanent residence in: ------------------------------------------- \\ \\
7.  Visa to be obtained in: ------------------------------------------- \\ \\
8.  Affiliation, Position, Work Address-------------------------------- \\ \\
9.  Passport: no--------, issued on-------------, valid --------------- \\ \\
\end{tabular}

{\bf Also attach copy of passport (the first page with photo), please.}

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{\it Please send this form to the conference secretary Julia Vahteeva}

\center {vahteeva@itp.ac.ru }





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