Visa Application Form

PLEASE SUBMIT NOT LATER THAN ON MAY 1ST, 2005

1. Last name(s) (as in passport):

2. First name(s) (as in passport):

3. Date of birth (dd-mm-yy):

19

3.1 Place of birth :

country city

4. Mr/Mrs:

5. Nationality:

6. Passport number:

7. Passport expiration date (dd-mm-yy):

20

8. Affiliation:

9. Position:

10. Address (official)

 

street address:

city:

postal code:

 

 

country:

13. Dates of visit:
(if not determined yet please put the earliest possible date of your arrival;
the visa will be given for 30 days beginning from this date)

from:   to:

14. Сountry & city (with a Russian consulate) where you will apply for a visa:
(you may find list of Russian consulates at
this list of consulates but please DO check it)

15. Fax copy of the official invitation is
SUFFICIENT / NOT SUFFICIENT
to obtain the visa in this consulate
Note: in many Russian consulates the invitation by fax is NOT sufficient to obtain the visa. Please, DO contact the consulate to clarify this question.

SUFFICIENT
NOT SUFFICIENT

16. Fax number/Mailing address to send the invitation to:
(please put fax number if fax copy of invitation is sufficient)

17. Russian cities planned to visit

1 2
3 4


I would like to come with accompanying person(s):
If "yes", please, make a separate visa form for each accompanying person:
fill in the same fields for everyone
(DO NOT omit affiliation, position, address and fax of the institution
FOR EMPLOYED and FOR STUDENTS or PUPILS).

yes no

Their names:

1 2
3 4

 



IMPORTANT:You have to send a copy of your passport (the pages containing your name, photo, passport number and passport expiration date) to the Organizing Committee of VPB 2005.
You may send it:

IMPORTANT: Please, check that your medical insurance is valid in Russia.

Please note that we CANNOT start the procedure of making the invitation for you (which takes some weeks) until we receive all the data requested and a copy of your passport page(s).