*Your contact E-mail address
asdf@adsd.ru
*Family Name (Last Name)
Brown
*First Name
Alexander
Middle Name (Other Names dividing by space)
Ivanovich John
*Gender
Mr.
Mr. Mrs.
*Country of work
China
*City
New York
Zip
119991
*Mailing and street addresses of work (street, building N, ZIP code, city, country, etc.)
Kosygina St., 19
Phone
+7-495-1374995
Fax
+7-495-9397070
*Organization (Full Official Name)
Vernadsky Institute of Geochemistry and Analythical Chemistry, Russian Academy of Science
*Organization (Short Name, abbreviation, for the badges)
Vernadsky Institute
Do you need the Hotel Reservation (Sputnik Hotel only)
Yes
Yes No
*Do you need our Visa Assistance
Yes
Yes No
Preliminary Titles of your abstracts, in quotes dividing by semicolon
"The history of Mars.";"The New Impactica."
Oral/Poster/PrintOnly Prefers
Oral
Oral Poster PrintOnly
Additional requests
I want to request to get to the Moon after party
*Citizenship
UK
*Date of birth
13 Dec. 1975
*Place of birth
Obninsk, Moscow region, USSR
*Permanent Residence
Ancoridge, Alaska, USA
*Passport Number
123154
*Passport Issued Date
13 Dec. 2005
*Passport Valid Until
13 Dec. 2009
*Position (post) at Institute
Head of Planetary Department
*Part-time residence in Russia (Hotel name)
Hotel Sputnik, Moscow
*The place (city and country) you will apply for a visa
Helsinki, Finland
*The planning date of arrival to Russia
13 Dec. 2009
*The planning date of depature from Russia
24 Dec. 2009