NAME ...................................................................



AFFILIATION ............................................................



ADDRESS FOR CORRESPONDENCE .............................................



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E-MAIL, PHONE, FAX .....................................................



I WISH TO PARTICIPATE (YES, NO, NOT YET DECIDED) (underline) ...........



I (DO, DO NOT) WISH TO PRESENT A TALK (underline) ENTITLED .............



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ACCOMPANYING PERSON(S)..................................................



SINGLE (DOUBLE) OCCUPANCY ROOM RESERVATION IN THE CRIMEA (underline)



I EXPECT TO ARRIVE AT .............. BY ............... ON .............



VIA .................. AND LEAVE ON.....................................

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