| Title/Gender: | |
| Prof.: | Not selected |
| Dr.: | Not selected |
| Mr. | |
| Family Name: | Shestov |
| First Name: | Lev |
| E-Mail: | l.shestov gsi.de |
| Affiliation for Badge: | ITEP, Moscow |
| Institute: | ITEP |
| Address (Street): | Bolshaya Cheremushkinskaya, 25 |
| Postal Code, City: | 117218, Moscow |
| Country: | Russia |
| Phone: | |
| Fax: | |
| Payment: | Bank transfer to GSI |
| Arrival Date: | January 29 |
| Departure Date: | February 3 |
| Room: | Four-bed room |
| I want to share my room with: | |
| Presentation: | No Presentation |
| Title: |