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:

Ms.          Mr.    

Given Names:

     

     

¨ Participating State

Please indicate country:

     

¨ Partner for Co-operation

Please indicate country:

     

¨ International Organization

Please indicate name of organization:

     

¨ OSCE Secretariat

Please indicate department:

     

¨ OSCE Field Operation

Please indicate name of FO:

     

¨ OSCE Institution

Please indicate name of institution:

     

¨ NGO

Please indicate name of NGO:

     

¨ Other:      

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

Should you require visa support, (a) the passport copy as well as information on (b) which Embassy the letter should be sent to, (c) the date of visa appointment and (d) who is funding the travel, should be sent to [email protected]. Please note that it can take up to 14 days to process, so applications should be lodged as soon as possible

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: