Registration Form Participant Details Salutation Mr. Mrs. Ms



Download 52.5 Kb.
Date24.12.2016
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TypeRegistration form



ASEAN Foundation

Training Workshop on Multilateral Diplomacy




Registration Form

Participant Details


Salutation Mr. Mrs. Ms.

Name:_________________________________________________________________________

Title:__________________________________________________________________________

Institution: ______________________________________________________________________

Address:_____________________________________________________________________________________________________________________________________________________

City: _________________________________ Postal Code: __________________________

Phone No: _____________________________ Fax No: ______________________________

E-mail Address: _________________________________________________________________

I would like to register for myself:

Early Registration (On or before 31 January 2004) USD 250

Normal Registration (from 1 February 2004 to Workshop) USD 275

Payment can be made ONLY by bank transfer to:



Name of Account : ASEAN Foundation

Account No. : 254.66.224

Name of Bank : ABN AMRO N.V.

Address of Bank : JSE Building, Jl. Jend. Sudirman Kav. 52-53

Jakarta 12089

This Registration Form may however be sent by fax or email to one of the organiser secretaries.

Please note that your registration will be considered only upon receipt of your payment/transfer together with the Registration Form.

The ASEAN Foundation Universitas Prof. Dr. Moestopo (Beragama)

Jl. Sam Ratulangi 2, Menteng Attn: Ms. Nuraini Chandrawati

Jakarta 10350 Jl. Hang Lekir I/8, Jakarta Selatan

Phone: (021) 3192 4833, 3192 4828 Phone: (021) 7261474

Fax: (021) 3192 6078 Fax: (021) 7252683

E-mail: secretariat@aseanfoundation.org






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