Please send it to the Conference Secretariat.
(Phone 66 2 3547505 ext: 1204, Fax 66 2 3547507, e-mail: nongluck@apcdfoundation.org)
APDF General Meeting and Conference
October 17-18, 2010

Registration form of General Assembly
Please printout and type or print

General Assembly (October 17)
The name of the person who represents the member organization and observers
One sheet for one person each.
1.Given name :2.Middle and Family Name (block letter) :3. Sex : Male______

Female ______

4.Official position to the General Assembly (Representative or observer(s) ):5. Organization:
Contact address of organization /home :Address for post:
Telephone:
Fax:
E-mail:6. Passport Details: Nationality:
Date of birth:
Place of birth:
Passport number :Date and place of issue:
Date of Expiry:
7.For visa, if you need an invitation, please inform the secretariat.
YesNo

8.Necessary service:
Braille program ___________,
Accessible transportation ______________As to sign language, those who need are encouraged to bring national signlanguage interpreter.
1

9. Selection of hotel accommodation
The secretariat will reserve your accommodation from the below.
_______ APCD (Basically those who have mobility difficulty)________Hotel De Moc________Prince Palace Hotel
Date of Check in _________________
Date of Check out _______________
If you wish other hotels, please book yourself.
10. Flight information
Arrival:Departure:
Please note that accessible transportation will be arranged for wheelchair users.
Others are requested to come to the hotel and the venue by yourselves.
11. Please write if you attend the ESCAP Social Development Committee meeting fromOctober 19-21, 2010
Yes __________________

No______________________

If yes and would like the secretariat to book the hotel until your departure, pleasewrite.

Signature ____________________________________________________
Date ________________________________________________________

2

Registration form of APDF Conference
October 18, 2010
One sheet for one person each.
1.Given name :2.Middle and Family Name (block letter) :3. Sex : Male______

Female ______

4.Official position in your organization
5. Organization:
Contact address of organization /home :Address for post:
Telephone:
Fax:
E-mail:6.Passport Details: Nationality:
Date of birth:
Place of birth:
Passport number :Date and place of issue:
Date of Expiry:
7.For visa, if you need an invitation, please inform the secretariat.
YesNo

8.Necessary service:
Braille program ___________,
Accessible transportation ______________As to sign language, please contact the secretariat.
9. Selection of hotel accommodation_______ APCD (Basically those who have mobility difficulty)________Hotel De Moc________Prince Palace HotelIf you wish other hotels, please book yourself.
Date of Check in _________________
3

Date of Check out _______________
10. Flight information
Arrival:Departure:
Please note that accessible transportation will be arranged for wheelchair users.
11. Please write if you attend the ESCAP Social Development Committee meeting from
October 19-21, 2010
Yes __________________

No______________________

If yes and would like the conference secretariat to book the hotel until yourdeparture, please write.
12. Participation fee for APDF Assembly Conference : US$100 per person to be collectedon site.
Note: The fee covers conference facilities, tea breaks for two days, lunch for two days,
dinner on 17 October. Participants who only take part in General Assembly andnot taking the lunch and dinner will be admitted free of charge.

Contacts:

Ms. Nongluck Kisorawong

Conference secretariat :APCD Foundation
Address : 255 Rajvithi Road, Rajthevi, Bangkok 10400, Bangkok, Thailand
Phone : 66 2 3547505 Ext: 1204
Fax :66 2 3547507

e-mail: nongluck@apcdfoundation.org
APDF Secretariat:
1-22-1, Toyama, Shinjuku-ku,Tokyo, 162-0052
Phone: 813-5292-7628, Fax : .813-5292-7630
e-mail: eueno@dinf.ne.jp4