ࡱ> {y|#` !bjbj\.\. 8^>D>D\2\2\28242M3n4n4n4n45\546LLLLLLL$Oh"RMP8}55P8P8Mn4n4&M0(:(:(:P8j8n4n4L(:P8L(:(:{G|Hn43 9&\28^GIlVMM HR9R$HRH-6h6J(:6<75-6-6-6MM9^-6-6-6MP8P8P8P8 D  Intergovernmental Coordination Group for the Indian Ocean Tsunami Warning and Mitigation System (ICG/IOTWS) Regional Seminar and Training Workshop on Tsunami Risk Assessment and Mitigation for Indian Ocean Countries Amari Watergate Hotel, Bangkok, 3 9 November 2009 APPLICATION FORM Deadline for applications: 18th September 2009. Successful applicants will be contacted by 25th September 2009. Applications should be sent to the ICG/IOTWS Secretariat by email ( HYPERLINK "mailto:iotws@unesco.org" iotws@unesco.org) or by FAX (+61-8-9226 0599). Please indicate: A. Are you policy /decision maker applying to attend the 2 day seminar only?  FORMCHECKBOX  (3-4 November 2009) Do you wish to apply for travel and accommodation support*?  FORMCHECKBOX  Or B. Are you a technical specialist/emergency manager applying to attend both the 2 day seminar followed by the 5 day workshop?  FORMCHECKBOX  Do you wish to apply for travel and accommodation support*?  FORMCHECKBOX  * Please refer to announcement letter for eligibility requirements for travel and accommodation support. PERSONAL INFORMATION NAMETITLE FORMCHECKBOX  DR.  FORMCHECKBOX  PROF.  FORMCHECKBOX  MR.  FORMCHECKBOX  MS.  FORMCHECKBOX  others _________GENDER FORMCHECKBOX  MALE  FORMCHECKBOX  FEMALEDATE OF BIRTH (DD-MM-YYYY) NATIONALITY ORGANISATION AND POSITIONADDRESS  TELEPHONE NUMBERFAX NUMBER  EMAIL ADDRESS   EDUCATIONAL BACKGROUND LEVELSCHOOLDEGREEYEAR GRADUATEDTERTIARY    MASTERS DOCTORAL POST DOCTORAL 3. TSUNAMI or RISK ASSESSMENT RELATED TRAINING TITLECONDUCTED BYINCLUSIVE DATES       4. TRAVEL INFORMATION PASSPORT NUMBER  DATE OF ISSUE  PLACE OF ISSUE  EXPIRY DATE  NEAREST INTERNATIONAL AIRPORT  5. ADDITIONAL INFORMATION Have you been officially nominated to attend this workshop by your countrys Tsunami National Contact (TNC)? 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