Registration Form CQIS-2021

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Email *

Please indicate circumstances (other then the pandemic situation inside Russia) that affect your ability to attend the conference (e.g., the international travel restrictions, the vaccination requirements, etc). If possible, please estimate the date by which the situation will be cleared up.

Title: *

Prof.

Dr.

Mr.

Mrs.

First Name(s) *

Family Name *

Sex *

Male

Female

Citizenship *

Affiliation

Would you like to give a talk? If yes, write the topic of your talk.

Your estimated date of arrival (note that July 25 is reserved as the conference arrival day) *

Your estimated date of departure (note that July 31 is reserved as the conference departure day) *

Do you need a formal invitation ? *

Yes

Home Institute Address( *to sent an invitation to)

Tel.

The Organizing Committee has made a preliminary reservation for the participants of the workshop at Gamma and Delta Sirius hotels. Please, indicate below if you are going to arrange your accommodation elsewhere.

I prefer to make a reservation in other hotel

I prefer to stay at Gamma or Delta Sirius hotels

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Accompanying persons, special requests.

If you need a financial support for covering your registration fee and/or hotel accommodation and/or travel expenses? Please, see below. *

Registration fee

Accommodation

Travel expenses

None of these

Required

I confirm my consent to the processing of my personal data, incl. by third parties, in order to organize my visit, to make a video recording and to use in HSE reports *

Yes

A copy of your responses will be emailed to the address you provided.

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