Colap 5 online Registration Form

Please use this form to register online for Colap 5 in Manila, Phillipinnes, September 18-19/2010

Personal information

Surname: *

First Name: *

Middle Name:

Birthdate:

Sex:

Male

Female

Nationality: *

Languages Spoken:

Profession:

If you are a professor or law student, what is the name of the school you are attending and course you are teaching or taking up?

Contact information

Current adress:

Phone number:

Please include country and area code

Mobile number:

Please include country code

Fax number:

Please include country and area codes

Email: *

Flight details

Arrival date/time:

Flight NO.:

Airline:

Departure date/time:

Flight NO.:

Airline:

Accomodation details

Hotel:

If other hotel::

Date of arrival:

In case of emergency

Person to contact:

Adress:

Phone number:

Please include country and area code

Mobile number:

Please include country code

Email:

Do you plan to extend your stay in the country ?

Extended stay:

yes

Reason:

Organization Details

Name:

Nature:

Adress:

E-mail adress:

Phone number:

Fax number:

Your position:

Who invited you to Colap ?

Name:

Organization:

Adress:

Phone number:

Please include country and area codes

E-mail adress:

Are you going to attend the NUPL Congress as well ?

Attendance NUPL Congress:

yes

Current health situation or medication the secretariat needs to be aware of::

Do you have any specifice dietary requirements ?

Dietary requirements:

yes

If yes which ?:

If other which ?:

Special request:

Workshops

I will participate in the following workshop on day 1:

I will present a paper with the following title in this workshop:

I will participate in the following workshop on day 2:

I will present a paper with the following title in this workshop:

I send you a copy of my paper as an attachment:

Files in the following formats can be attached to this form: .doc, .txt, .pdf, . rtf, .zip with a maximum size of 800 KB. Papers can also be submitted in a later stage by sending them to colapV2010@gmail.com

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Colap 5 online Registration Form