2015 Mediterranean Conference
“Common security in the Mediterranean region – challenges and opportunities”
Hashemite Kingdom of Jordan, 20 - 21 October 2015

Registration Form

Please complete by typing in the white cells;  to tick the check boxes, please double click on them and choose the “checked” option

Name of State / Institution: 	
     	
Please tick one of the categories below:	
 Participating State     	 Partner for Co-operation	 International Organization	 Academic Community      NGO   	 OSCE Secretariat 	 Other:      	

Family Name:	Ms.		Mr.		
     	

Father’s Name (if applicable):	Given Name(s):	
     	     	

Title / Position as to appear on the list of participants:	
     	

Nationality:	E-mail address:	
     	     @     	
Mobile #  with all prefixes, including national code:	Contact details at home in the event of an emergency:	
     	     	

Arrival 	Flight #:	     	Departure 	Flight #:	     	
Date: 	     	Time:	     	Date:	      	Time:	     	

During the Conference, I will stay at the Mövenpick Resort Dead Sea    and will be accompanied by person(s)
Alternatively, I can be reached under the following address / tel. / fax #:	
     	

Date:	     		Signature: 	     	

Please submit this form not later than by 5 October 2015 COB 
e-mail:    pm-extco@osce.org