REGISTRATION FORM
for the participation in international conference and summer school
«EARLY INTERVENTION: FROM THEORY TO PRACTICE» 
Devoted to the 25-th anniversary of the approval of the priority of St. Petersburg Social Program «Habilitation of infants»
13-23 June 2017, St. Petersburg, Russia

Last name and First name

	
Country, city and 
the name of organization	
	
Work or education position	
	
E-mail	
	
Main topic of your study or practical work	

Title of a report (if scheduled)