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

Registration Form for Media

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 Media: 	
     	

Family Name:	Ms.		Mr.		
     	

Given Name(s):	
     	

Title / Position:	
     	

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

Please submit this form not later than by 15 October 2015, 16:00 
e-mail:    press@osce.org