MOLODVA EOM 2016
Observer Registration Form
Republic of Moldova
Presidential elections 30 October 2016
Registration Date:
(dd.mm.yy)
PERSONAL INFORMATION
(Please answer each section clearly, completely and use only English transcription)
Family Name:
First Name:
Nationality:
Passport Number:
Passport Type:
Passport Issue Date:
Diplomatic/Regular/Service
Date of Birth:
Mobile in the field:
(country code +number)
Email:
Working Language:
E-day Interpretation:
Passport Expiry Date:
ENG –RUS –FR –SP–IT-GER
ENG –RUS –FR –SP–IT-GER
CONTACT PERSON
(Indicate contact details for the person in charge of practical arrangements for your participation)
First Name &Surname:
Mobile:
Email:
TRAVEL INFORMATION
(Observers are advised to arrive in Chisinau on 27 October to participate in briefings on 28-29 October and can depart in the
afternoon of 31 October)
Arrival Date:
(dd.mm.yy)
Arrival Time:
(hh:mm)
Arrival Flight:
VISA required:
YES
Departure
Date
:
(dd.mm.yy)
Departure Time:
(hh:mm)
Departure Flight:
NO
ARRANGEMENTS ON ELECTION DAY
Preference of Deployment Partner:
(if any)
Car on Election Day
Interpretation on Election
Day
OSCE
OSCE
Embassy
Embassy
Own
Arrangements
Own
Arrangements
DEPLOYMENT LOCATION
Chisinau
Willingness to travel by car outside Chisinau (up to 90 minutes)
Willingness to overnight outside Chisinau
(The International Secretariat will provide suggestions)
Please return this form together with a passport copy by
Tuesday 27 September 2016
to
the OSCE PA International Secretariat
fax +45 33 37 80 30
OSCE PA MOLODVA EOM 2016
DATE_________ RECORD #_________