Dear colleague, 

If you need Russian entry visa, please fill out 
the enclosed form, and return it to meso2000@itp.ac.ru, 
or send it by fax: 7 (095) 938 20 77  

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1. Last (family) name:	_________________________________________

   First name:		_________________________________________

   Middle name(s):	_________________________________________

2. Date of birth:	__/__/____ (dd/mm/yy)

3. Citizenship:		_________________________________________

4. Passport number:	_________________________________________

	valid till:	__/__/____ (dd/mm/yy)

5. Affiliation (in full):	_______________________________________
				
				_______________________________________
				
				_______________________________________
				
				_______________________________________
				
6. Position:	_______________________________________________________

                _______________________________________________________

7. Address (at work):		_______________________________________
				
				_______________________________________
				
				_______________________________________
				
				_______________________________________
    
      Phone:	_______________________   FAX:	_______________________
				
				
8. Date of entry:	__/__/____ (dd/mm/yy)

   Date of exit:	__/__/____ (dd/mm/yy)

   Number of entries:   __________
 
   Duration of stay:    __________

9. Which cities in Russia are you going to visit?

    ________________________________________________________________________
    
    ________________________________________________________________________
    
    ________________________________________________________________________
    

10. The city at which you are going to receive the visa
    (please check for the Russian consulate):
    
    ________________________________________________________________________