1st Nexus Roundtable in the MENA and wider Mediterranean, (26-28 November 2018, Beirut, Lebanon)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

All participants to the Roundtable need to submit this form and are expected to cover their own travel and accommodation costs, unless they have been explicitly offered financial support by the organisers. For more information, please contact zoe@gwpmed.org.
Tous les participants à la table ronde doivent soumettre ce formulaire et sont censés de couvrir leurs coûts de voyage et de logement, à moins que les organisateurs leur aient explicitement offert du soutien financier. Pour plus d'information veuillez contacter zoe@gwpmed.org

Email *

1.Title

Ms./Mme.

Mr./M.

Dr./Dr.

Clear selection

2. Name – Prénom:

3. Surname – Nom:

4. Gender – Sexe:

5. Organisation/ Organisation:

6. Position / Title - Poste / Titre:

7. Country-Pays:

8. Tel -Tél/ Mobile - Portable:

9. Fax:

10. E-mail – Courriel:

11. Visa requirement: If you require visa for your travel please send a copy of your passport at zoe@gwpmed.org/ Obligation de visa:si vous avez besoin d’un visa, veuillez envoyer une copie de votre passeport zoe@gwpmed.org

YES/OUI

NO/NON

Clear selection

12. Kindly inform us if you would like to join the dinner on Tuesday 27 November / Veuillez nous informer si vous souhaitez participer au dîner le mardi 27 novembre.

YES/OUI

NO/NON

Clear selection

13. Please state any food allergies or dietary preferences / Veuillez indiquer vos allergies alimentaires ou vos préférences diététiques.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms