Arab Region Regulatory Harmonization Initiative Kick-off MeetingManama, Bahrain, 21-22 Ootober 2007 Fellowship Form

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Arab Region Regulatory Harmonization Initiative Kick-off MeetingManama, Bahrain, 21-22 Ootober 2007 Fellowship Form Powered By Docstoc
					                                                                                                                 ANNEX 2


                     Meeting on Arab Region ICT Market Harmonisation
                                    Manama-Bahrain, 21-22 October 2007



Please return to:                    Meetings Organization &                  E-mail : bdtfellowships@itu.int
                                     Support (MOS) – ITU/BDT                  Tel: +41 22 730 5487 / 5095 / 6057
                                     Geneva (Switzerland)                            Fax: +41 22 730 5778


                  Request for a fellowship to be submitted before 10 October 2007

                                        Participation of women is encouraged

Country                 ________________________________________________________________________________________________________


Name of the Administration or Organization       _________________________________________________________________________________


Mr. / Ms.               ________________________________________________               ________________________________________________
                               (family name)                                                     (given name)

Title _________________________________________________________________ _______________________________________________________


Address ________________________________________________________________________________________________

  __________________________________________________________________________________________________

Tel.:       ___________________     Fax: ___________________         E-Mail ___________________                      ________________________


PASSPORT INFORMATION :

Date of birth           _______________________________________________


Nationality             ___________________________________          Passport number          ________________________________________


Date of issue             _________________     In (place)   ____________________________       Valid until (date)       ___________________



CONDITIONS

1. One fellowship per eligible country.
2. One return ECO class airticket by the most direct/economical route.
3. A daily allowance to cover accommodation, meals and incidental expense
4. Imperative that fellows be present first day/end of the meeting.



Signature of fellowship candidate       __________________________________________________              Date         ________________________


TO VALIDATE FELLOWSHIP REQUEST, NAME AND SIGNATURE OF CERTIFYING OFFICIAL DESIGNATING
PARTICIPANT MUST BE COMPLETED BELOW WITH OFFICIAL STAMP.


Signature:___________________________________________________Date:_____________________________________