The Conference Application Form

“The 14th Korolev’s Readings”

PARTICIPANT REGISTRATION FORM

Institution _________________________________________________________________________________

Session____________________________________________________________________________________

Report title_________________________________________________________________________________

Presenter’s full name _________________________________________________________________________

Student status (undergraduate / graduate /  post-graduate) __________________________________________

Research supervisor (full name, degree, institution, department)______________________________________

Postal address with zip code____________________________________________________________________

Contact phone number _______________________________________________________________________

E-mail ____________________________________________________________________________________

Head of the Department _________(full name)

                                  ( signature)