Transcript
Registration Form for the 13th
INWEPF Steering Meeting and Symposium
Phnom Penh & Siem Reap– Cambodia – 6-8 December 2016
Delegate Information
Title Mr. ( ) Mrs. ( ) Ms. ( ) Dr. ( ) Prof.( )
Name Passport No.
Country Gender Male ( ) Female ( )
Position
Organization
Address
City Zip Code
Email Fax
Phone Mobile phone
Date of Birth (Month/Date/Year)
Type of Participation
Presentation ( ) Local organization Nominee ( )
Country Representative ( ) General Participant ( )
Photo
Hotel Reservation (Foreign participants only )
Hotel Type
Cambodiana Hotel in Phnom Penh ( )
Angkor Century Hotel in Siem Reap ( )
Room
Type
Check in Date Check out Date
Participation to Field Visit
Yes
No
Remarks Vegetarian ( ) Non- Vegetarian ( ) Halal only ( )
Attach a photo