Sseayp

The 25th SSEAYP International General Assembly 2013 In Vientiane Capital, Lao PDR

REGISTRATION FORM
“SSEAYP International: SSEAYP together Experience Culture”

PERSONAL INFORMATION
1 2 3 4 5 Name (As shown in passport) Nationality Passport Details (Please attach your passport copy) Gender Date of Birth (dd/mm/yyyy) First Name: Last Name: Passport Number: Expiry Date: Type: ☐Ordinary ☐ Official ☐Female ☐ Male Age ☐Ex-PY of SSEAYP (Year:) ☐Ex-NL of SSEAYP (Year:) ☐Ex-Facilitator of SSEAYP (Year:) ☐Spouse of Ex- PY /NL/ Facilitator of SSEAYP (Name:) ☐Family of SSEAYP (Name:) ☐Host Family of SSEAYP ☐Ex-PY of INDEX (Year:) ☐Ex-PY of SVVY (Year:) ☐Friends of Ex-PY ☐ Member ☐ Board Members, position: ___________________ ☐ Other: ___________________________ Address: Phone: Mobile: Email: Name of Office / School: Office / School 10 (Please add country code to Phone / Mobile ) Position: Address: Tel: Mobile: Email: ☐ Yes, Please specify: ☐ No ☐ Yes, Please specify: ☐ No years old

6

SSEAYP Experience

7

Position in Alumni Association Residential address and Contact Details (Please add country code to Phone / Mobile ) Occupation

8

9

11 Religion 12 Food Restrictions/ Allergies

13 Prescription Drugs

Name: Emergency Contact 14 (Please add country code to Phone / Mobile ) Relationship to you: Phone: Mobile: Email:

TRAVEL INFORMATION
Arrival Arrival date: Arriving Laos by: ☐ Wattay International Airport, Flight Number: ☐ Lao-Thai Friendship Bridge: Accommodation Name: , Contact : Departure date: Departure from Laos by: ☐Wattay International Airport, Flight Number: ☐ Lao-Thai Friendship Bridge: Arrival time: : hrs

Early Arrival

If you arrive in Laos earlier please provide your accommodation before SIGA

Departure time:

:

hrs

Departure Late Departure

If you willing to extend your stay in Laos, please provide your accommodation after SIGA

Accommodation Name: , Contact: <IMPORTANT INFORMATION>
Those who arrive earlier or extend their stay should arrange their