Press registration

RUSNANOTECH Forum electronic registration form for mass media

First name*
Last name*
Mass media full name (without indication of the legal organization form)*
Editorial office telephone*
Mobile telephone (in the format as follows: +7 code, telephone number without dashes or blanks) *
Contact e-mail*
Your special wishes concerning your work at the Forum
Passport series and No*
Issuing authority with indication of subdivision*
Date of passport issue*
Registered residence address*
Actual residence address if other than the registered one
Place of birth*
Date of birth*