Please send
to Holograte Co. on fax: +7 (812) 314 8214
mail: alla@holograte.com
 and to BMSTU on fax: +7 (499) 263 6344
mail: odinokov@rl2.bmstu.ru

APPLICATION FORM

 for participation in the 5-th conference
“Holography in Russia and abroad. Theory and practice”

June 30 – July 02, 2008, Saint-Petersburg, Russia

Full Exhibitor firm/company name:________________________________________________________________________________________________________________________________________________________________________________________________________________________
Legal address_____________________________________________________________________________________________________________________________________________
Tel:_________________________Fax:_____________________
E-mail:______________________
Bank requisites: ____________________________________________________________________________________________________________________________________________________
Person in charge: (name, position):____________________________________________________
Tel. _______________________Fax: _____________________
E-mail: _______________________

Conditions of payment:


1) Registration payment for participants of conference without the report is 500 dollars USA (for one person).
For 2 participants of conference - discounts of 10 %;
For 3 participants of conference - discounts of 20 %.
2) Registration payment for participants with the report accepted by program committee is 250 dollars USA(for one person).
For 2 participants of conference - discounts of 10 %;
For 3 participants of conference - discounts of 20 %.
Overall cost: $__________________________________________________________________

Date____________________________ Signature  _______________________________ Stamp