ESCAP Regional Workshop - Participant Registration

	UN ESCAP Workshop on Regional Follow-up to the Fifth Session and Preparation for the Sixth Session of the Ad Hoc Committee on an International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities Bangkok, Thailand, 26-27 July 2005

Return to Main page	Participant Form Please printout, and type or print
In order to enable ESCAP to facilitate administrative arrangement on your behalf, kindly complete and return this form as soon as possible to Mr Jerrold W. Huguet, Chief, Population and Social Integration Section, Emerging Social Issues Division, Economic and Social Commission for Asia and the Pacific, 6th Floor, United Nations Building, Rajadamnern Nok Avenue, Bangkok 10200, Thailand, fax: (66-2) 288-1030 E-mail: akiyama @ un.org or escap-esid-psis @ un.org
1. Given name:
2. Family Name: (block letters)
3. Sex:	___ Male ___ Female
4. Official Designation:
5. Contact Address:
	Telephone:
	Fax:
	Email:
6. Passport Details:	Nationality:
	Date of birth:
	Place of birth:
	Passport No.:
	Date and place of issue:
	Date of Expiry:
7. Type of disability you would like to let us know

Title and signature of the designating official Date

Participant Form