CDIA Annual Stakeholders’ Forum

If you wish to download a PDF version of this form, you may do so here. A copy of the Draft Agenda can be downloaded here.

PLEASE RETURN THE FORM BY EMAIL OR FAX ON OR BEFORE 09 NOVEMBER 2011:
Ms. Elvie B. Salaver, Events Coordinator, Email: pro_poor2011@cdia.asia; Fax: (+632) 631 6158

REGISTRATION / CONFIRMATION FORM

28 November 2011
Bangkok, Thailand

PERSONAL INFORMATION
Select one:*
Name*
PrefixFirstLastSuffix
Country*
Nationality*
Organization/Unit/Division*
Position*
Address*
Street AddressCityState / Province / RegionZip / Postal CodeCountry
Business Telephone*
Business Fax*
Residence Telephone*
Mobile No.*
Email*
Other Email
Dietary Restrictions
EMERGENCY CONTACT INFORMATION
Name*
FirstLast
Relationship*
Home Telephone*
Business Telephone*
A limited number of sponsorships are available. Please indicate if you will require support to attend.
- I will require sponsorship for Hotel Accommodation
- I will require sponsorship for Travel
The SHF is being held back-to-back with the CDIA Regional Forum on PRO-POOR URBAN INFRASTRUCTURE INVESTMENTS IN ASIA 29 November – 01 December 2011. Please indicate if you wish to also attend this event:
- Yes, I will also attend this event
Visa Assistance
(If assistance is needed, please provide us a copy of the first page of your passport. Your passport should be valid at least six (6) months valid before travel time).
Do you need a visa support letter for Thailand?*
- Yes
- No
Visa Pick-up/Collection Point:
Passport No.
Flight Details (For non-sponsored participants):
Please indicate your estimated time of arrival (ETA) and your estimated time of departure (ETD) for your hotel accommodation arrangements.
Date of arrival
ETA
Estimated Time of Arrival
Flight No.
Date of departure
ETD
Estimated Time of Departure
Flight No.
Verification

REGISTRATION / CONFIRMATION FORM

PERSONAL INFORMATION

EMERGENCY CONTACT INFORMATION

Visa Assistance

Flight Details (For non-sponsored participants):

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