Embassy of _______________________ in _________________________
Address _____________________________________________________
Phone _______________________________ Fax ____________________

Almaty, city phone code is 7272
* Contact name, phone number ___________________________________
* Your local address ___________________________________________
* phone number ________________________________________________
* Address in Cyrillic ___________________________________________
* Medical clinic/hospital address and phone _________________________
    __________________________________________________________
* Other Almaty information _____________________________________

City of __________________________
* Contact name, phone number ___________________________________
* Your local address ___________________________________________
* phone number ______________________________________________
* Address in Cyrillic ___________________________________________
* Medical clinic/hospital address and phone _________________________
    __________________________________________________________
* Other local information ________________________________________

Long distance card number, PIN __________________________________
access number_________________________________________________
Alternate company/access number _________________________________

Airline/phone _________________________________________________
address ______________________________________________________

Personal information
Full name ____________________________________________________
Blood type ___________________________________________________
Allergies _____________________________________________________
Medications __________________________________________________
Height ______ cm, weight _______ Kg
Insurance carrier, phone number __________________________________
In case of emergency, contact ____________________________________
Additional contact _____________________________________________
Additional contact _____________________________________________

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