REGISTRATION FORM
for the International Workshop

Frontiers of Particle Astrophysics

Kiev, Ukraine

June 21-24, 2004

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)..................................................




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



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

 
 

Please, return the filled-in Form by mail, e-mail, or fax at you earliest convenience to:

 

Astro-04
Bogolyubov Institute for Theoretical Physics 
Kiev 03143, UKRAINE

E-mail: jenk@gluk.org

Fax: ++38-044-2665998