host) FUND ST PETERSBURG INTERNATIONAL ECONOMIC FORUM, SREDNIY PROSPECT 88, BUILDING A, ST PETERSBURG, RUSSIA, 199106 14. Itinerary(places of dui) SAINT-PETERSBURG "15. Do you have a medical insurance valid in Russia? yes x Please specify? UNITED HEALTHCARE no 16. Who will pay for your trip to and stay In

I og) FUND ST PETERSBURG INTERNATIONAL ECONOMIC FORUM, SREDNIY PROSPECT 88, BUILDING A, ST PETERSBURG, RUSSIA, 199106 14. Itinerary(piaces 'grist) SAINT-PETERSBURG "15. Do you have a medical Insurance valid in Russia? yes x Please specify? UNITED HEALTHCARE no 16. Who will pay for your trip to and stay In

: NONE Invitation No: NONE Directive NO: NONE Address: 2 ISVETNOI BOULEVARD, MOSCOW, RUSSIA 127051 12. Route of journey (destination MOSCOW, SAINT-PETERSBURG points). Photograph and signature. Place for photograph Date (dd/mm/yyyy), personal signature Service information (automatically generated). A