PRE-REGISTRATION FORM
to attend
XXI International Conference

RELAXATION PHENOMENA IN SOLIDS

October 5 - 8, 2004
Voronezh, Russia

Family name:
First name:
Second name:
Academic degree:
Affiliation:
Address:
Zip code, City:
Phone:
Fax:
E-mail:
I will be accompanied by person(s)
I plan to present	an oral a poster
report entitled

This form should be sent before April 30, 2004 to Conference Secretary by E-mail or regular mail