Parliamentary Observer Registration Form
Parliamentary Elections in Moldova, 30 November 2014
Registration Date:
(dd.mm.yy)
PERSONAL INFORMATION
(Please answer each section clearly, completely and
Family Name:
First Name:
Nationality:
Passport Number:
Passport Type:
Diplomatic Regular Service
use only English transcription)
Mobile in the field:
(country code +number)
Email:
Languages:
ENG RUS FR SP IT GER
CONTACT PERSON
(Person in charge of practical arrangements)
First Name &Surname
:
Mobile:
Email:
Departure
Date
:
(dd.mm.yy)
Departure Time:
(hh:mm)
TRAVEL INFORMATION
Arrival Date:
(dd.mm.yy)
Arrival Time:
(hh:mm)
Arrival Flight:
TRANSPORTATION
To/From the Airport (in
Chisinau)
Not Required
(Embassy/ Own arrangements/ etc)
Departure Flight:
Required
DEPLOYMENT ON ELECTION DAY
Preference of Deployment Partner:
(if any)
Car on Election Day
Interpretation on Election
Day
E-day Interpretation
OSCE
OSCE
ENG
RUS
Embassy
Embassy
FR
SP
Own
Arrangements
Own
Arrangements
IT
GER
PREFERENCE FOR DEPLOYMENT LOCATION
Chisinau city
Willingness to travel by car outside Chisinau city (up to 90 minutes)
Willingness to overnight outside Chisinau
(The International Secretariat will provide suggestions based on requirements)
Please return this form together with a passport copy by
7 November 2014
to
Ms. Iryna Sabashuk OSCE PA Secretariat tel: +45 33 37 80 47 fax +45 33 37 80 30
OSCE PA
Page 1 of 1
Record #: _________