APPLICATION FORM FOR A FINANCIAL SUPPORT
(to participants from C.I.S.)

(deadline for submission 1 June 2003)

Family Name:
First Name:
Sex:	Male Female
Position (title):
Organization:
Mailling Address:
City:
Code:
Country:
Phone:
Fax:
E-mail:

I would like to apply for a financial support for participation in the XVIIth International Workshop in Samara-Saratov (Russia, 4 - 11 September, 2003) to cover:

Accommodation fee:	Yes No
Registration fee:	Yes No