GLOBE INTERNATIONAL

 

Brasilia Legislators Forum

 

19^th – 21^st February 2008

 

Registration Form

 

** This form must be completed to confirm your participation

and accommodation**

PLEASE RETURN TO EMAIL: [email protected]  FAX: +44 (0)20 7222 6959

ALL REGISTRATION FORMS MUST BE RETURNED BY 14th January 2008

 

First Name                              Â Â Â Â Â Â Â Â Â Â Â  Surname                       

 

Title                                                  Country                       

 

Full Name                               

(as you would like to appear on your delegates badge)

 

Date of Birth                           Â Â           

 

Parliament / Organisation          Â Â            Position / Employment     Â 

 

Full Address                            

 

Contact telephone number                    Mobile / Cell Phone         

 

 (Please provide in case of an emergency)

 

Name & Contact of Person to Contact in an Emergency      

 

Country Code                                      Fax Number (with country code)     

 

Email address                          

 

**Please provide an email address that you check as key Dialogue information will be sent by email to minimise costs**

 

Your Website address                        

 

Please advise how best to contact you

 

E-Mail     Fax     Phone     Mail   

 

Travel

 

Date of Arrival                        Â Â  Time of Arrival                                    

 

Mode of Transport                   

(if you are flying please provide your flight number)

 

Date of Departure                                Time of Departure                    

Mode of Transport                   

(if you are flying please provide your flight number)

 

We kindly ask all participants to make arrangements for transfer from the airport to the hotel either by taxi or through your embassy.

 

PLEASE ALSO ARRANGE YOUR OWN PERSONAL TRAVEL INSURANCE, GLOBE INTERNATIONAL DOES NOT PROVIDE RELEVANT TRAVEL INSURANCE

 

 

Personal Information Continued…

 

 

if you have not already PREVIOUSLY done so for a GLOBE Forum please provide your photograph and a one page biography, in electronic form for the delegates information pack and for the Dialogue website

 

Accommodation

 

On which nights do you require accommodation in Brasilia:

 

Tuesday 19^th February                                  

 

Wednesday 20^th February                    

 

Thursday 21^st February                       

 

If you require any other nights please indicate      

(please note that the Dialogue can only accommodate 3 nights unless specific reasons exist for additional nights accommodation)

 

Do you require a Smoking Room             Non-Smoking Room            

 

Other Requirements

 

Do you have any dietary requirements   

 

Do you have any disabilities                 

If so please detail any requirements      

Please indicate if there is anything else the organisers should be aware of      

Interpretation

 

Please note the working language of the Dialogue will be English. Please indicated below your level of English and if you require interpretation provision

 

Level of English competency          Fluent    Conversational    Limited    None 

 

Do you require translation facilities  Yes   No    If yes - language Required 

 

Visit to the Amazon & an Ethanol Facility

 

Please indicate if you would like to visit the Amazon

(3 night additional visit either before or after the Forum)

 

      I would like to visit the Amazon from the 16^th-19^th Feb

      I would like to visit the Amazon from the 22^nd-25^th Feb

 

Please indicate if you would like to visit an Ethanol Production facility

(Only possible if your flight is routed through Sao Paulo)

 

      I would like to visit an Ethanol production facility when arriving in Brazil

      I would like to visit an Ethanol production facility when departing Brazil

 

PLEASE RETURN TO EMAIL: [email protected]  FAX: +44 (0)20 7222 5969

ALL REGISTRATION FORMS MUST BE RETURNED BY 14^th January 2008