US EMBASSY MOSCOW REGISTRATION FORM

Please complete this form and E-mail or FAX as indicated below or Register On Line at: https://travelregistration.state.gov/ibrs/

Passport Number______________________ Date of Issuance of Passport________________

Place of Issue of Passport______________________________________________________

Organization with which you are affiliated

        _____________________________________________________________________

Daytime telephone number________________ Evening Telephone Number________________

Emergency Contact in the States__________________________________________________

Their Telephone Number _________________        Relationship to You___________________

PLEASE CAREFULLY CONSIDER THE QUESTIONS BELOW BEFORE ANSWERING.

DO YOU WISH TO WAIVE YOUR RIGHT TO PRIVACY?

Note:  The information you have provided is protected as confidential and cannot be released, even to relatives, without your consent. 

Please Note:  Your name and phone number will be given to a warden in order that they may contact you in case of an emergency. 

_____ Yes, I consent to release this information to all people who inquire

_____ No, I do not waive my right to privacy. 

_____ I wish to release this information only to the following individuals:

 __________________________________________________________________________________________

Would you be willing to assist the Embassy in contacting Americans in the event of an Emergency?

____ Yes, I would like to be a warden and assist the Embassy in contacting Americans in the event of an Emergency. 

____ No, I do not wish to be a warden. 

_________________________________________________                        __________________

Please SIGN your name on the line above                                                                Date

E-mail address: moscowwarden@state.gov

FAX Number:  (095) 728-5084

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Visitor Registration

All U.S. citizens residing in Russia are encouraged to register with the nearest U.S. Consulate or Embassy. Registration allows us to: replace your passport quickly if it is lost or stolen; contact you in case the Embassy or your relatives need to pass you an emergency message and release information about you to others in accordance with your wishes (as stipulated by the U.S. Privacy Act of 1966). To register, you may send us by fax or email a copy of your U.S. passport and fill out the attached simple form. Or register on line at: https://travelregistration.state.gov/ibrs/ . Remember, registering with the appropriate consular office upon arrival greatly facilitates our ability to locate you in the event of an emergency.

Our email address is moscowwarden@state.gov

Our fax number is (095) 728-5084