INTERNET FREEDOM CONFERENCE
Vienna, 13 October 2017
Registration Form
Please submit this form not later 2 October 2017 bye-mail to [email protected]
SECTION 1
Please complete in ENGLISH and in CAPITAL LETTERS
Family Name: |
Given Names: |
|
|
Title / Position as to appear on the list of participants: |
Tel No. with all prefixes, including national code: |
E-mail address: |
||||||||||||||||||
I will attend the reception: ¨ YES ¨ NO (please tick) |
|||||||||||||||||||
SECTION 2 TO BE FILLED IN BY NOT PERMANENTLY ACCREDITED DELEGATION MEMBERS AND PERSONS REQUESTING VISA SUPPORT LETTERS
|
|||||||||||||||||||
Nationality |
Current country |
Date of birth |
|||||||||||||||||
of residence |
Day |
Month |
Year |
||||||||||||||||
|
|
|
|
|
|||||||||||||||
Passport number |
Issued on and by |
Passport type |
Expiry date |
||||||||||||||||
Diplomatic |
National |
Other |
Day |
Month |
Year |
||||||||||||||
|
|
||||||||||||||||||
Arrival |
Flight #: |
Departure |
Flight #: |
||||||||||||||||
Date: |
Time: |
Date: |
Time: |
||||||||||||||||