Women and Disability Workshop - Participant Registration

	UN ESCAP Workshop on Women and Disability: Promoting Full Participation of Women with Disabilities in the Process of Elaboration on an International Convention to Promote and Protect the Rights and Dignity of Persons with Disabilities 18-22 August 2003 Bangkok, Thailand
	Participant Form Please print out, 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: <nagata @ un.org> or <escap-esid-psis @ un.org>.
1. Given name:
2. Family Name:
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:

Title and signature of the designating official Date

Participant Form