InternatIonal ParlIamentary ConferenCe on SuStaInabIlIty, energy
& DeveloPment
monDay 14 – thurSDay 17 marCh 2016
WeStmInSter, lonDon – uK
nomInatIon form
Legislatures/CPA Branches may apply for
TWO parliamentarians.
When nominating their delegates, legislatures are reminded to
note the nomination criteria as outlined in the invitation.
Legislature/Branch:
(e.g. Parliament of Tanzania, CPA Namibia)
Name of FIRST Parliamentarian:
(please include title(s) and honorific(s), e.g. Hon., MP, etc)
Male
Female
Government
Opposition
Political Party:
(if applicable)
CARIBBEAN
REGIONAL
Year elected/nominated:
WORKSHOP
ASIAN
REGIONAL
WORKSHOP
AFRICAN
REGIONAL
WORKSHOP
Current position(s) held:
(e.g. Ministerial, Committee membership, etc)
Other relevant experience and/or knowledge of subject matter:
(e.g. former career, membership, attended similar
workshops, COP21, etc)
Name of SECOND Parliamentarian:
(please include title(s) and honorific(s), e.g. Hon., MP, etc)
Male
Female
Government
Opposition
Political Party:
(if applicable)
Year elected/nominated:
Current position(s) held:
(e.g. Ministerial, Committee membership, etc)
Other relevant experience and/or knowledge of subject matter:
(e.g. former career, membership, attended similar
workshops, COP21, etc)
IMPORTANT: FUNDING ARRANGEMENTS
There is a small amount of funding support available. If it is anticipated that your legislature will require financial
support to cover certain aspects of your delegation’s participation at the IPC, please indicate so by marking the
relevant box (a ‘Request for Funding Form’ will be sent to your legislature upon the confirmation of places at the
Conference):
Yes
No
Please complete this form and return it to CPA UK by
22 January 2016.
Please return it to (Email: [email protected],
alternatively send to the following: Fax: +44 (0)207 233 1202 or Post to: IPC SDG, CPA UK, Westminster Hall, Houses of
Parliament, London SW1A 0AA, UK