Please type or print in ink.
Please complete and send this form to: (Preferably by email or fax)

	Ms. Roselle Agana 
	ILO Subregional Office for South East Asia and the Pacific
	Tel. No.: (+632) 580-9919
	Fax No.: (+632) 580-9999 or (+632) 580-9992
	E-mail: agana@ilomnl.org.ph
	Mail address: 6819 Ayala Avenue, 1229,  Makati City,
	P.O. Box 4959 Philippines

In order to process the necessary travel arrangements and hotel bookings,
nomination forms are required on or before 1 April 2005.

Personal Information of  Nominee:

Family Name:____________________________   Gender: Female ________ / Male _________

First Name   :____________________________   Date of Birth: (dd/mm/yy) _______________

Passport No.:_____________________   Date of Issue: (dd/mm/yy) _______ Expiry: ______

Address through which notification about travel arrangement should be transmitted:
						       
Telephone:  _______________________________   Fax No.: _____________________________

Email address: _____________________  Additional contact info.: _______________________

Organizational Information:

Country represented: ______________________________________________________________

Nominee’s organization:  __________________________________________________________

Position of the nominee in the nominating organization:  ____________________________

Is the participant a designated ILO Governing Body representative/member? Yes__/No___

Person to contact in case of emergency:

Name: ___________________________________________________________________________

Address:  ________________________________________________________________________

Telephone_______________________________   Fax No.: ______________________________

Email address: ________________________  Additional contact info.: ___________________

 
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To be completed by nominating organization:

	I certify that the above nominee has been nominated for the Forum.
She/He is proficient in English and accepts the condition governing the Forum.

			

				          ________________________________
				          	             Signature


(to be signed by the person making the nomination)

Name: ___________________________________________________________________________

Designation: ______________________________________________________________________

Nominating Organization: __________________________________________________________

Address: __________________________________________________________________________

Date: _____________________________________________________________________________