SIM | Entry info | Entry form

Fields marked with asterisk (*) must be filled out.

Family name*

First Name*

Street and house
number*

ZIP Code*

City*

Country*

Date of Birth*
19
^{(month/date/year)}

Sex*

Distance*

Phone (with area code)*

Fax (with area code)

E-mail

If you have any queries please do contact us:

P.O. Box 41,
Glavpostamt,
644099, Omsk,
Russia
Phone/Fax: +7-3812-242-567
E-mail: sim@omsknet.ru