2013 OSCE-Australia Conference on Improving the Security of Women and Girls
Adelaide, Australia, 18 - 19 March 2013
Registration Form
Please complete in capital letters
State / Institution:	
     	

Family Name:	Ms.		Mr.		Given Names:	
     	     	

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

Nationality	Current country	Date of birth	
	of residence	Day	Month	Year	
     	     	     	     	     	

Passport number	Country of issue	Passport type	Expiry date	
		Diplomatic	National	Other	Day	Month	Year	
     	     				     	     	     	

The request for the Australian visa will be submitted:	
online ; 	through my travel agent ; 	at the Australian diplomatic mission in Vienna ; in      	(country)	

Mobile No. with all prefixes, including national code:	E-mail address:	
     		     @     	
Fax No. with all prefixes, including national code:	Contact details at home in the event of an emergency:	
     	     	

Arrival 	Flight #:	     	Departure 	Flight #:	     	
Date: 	     March 2013	Time:	     	Date:	      March 2013	Time:	     	

Participation in the academic seminar organized by the Flinders University	
I will participate                          I will not participate  	

Participation in the cultural programme hosted by the Government of South Australia	
I will participate alone             I will participate and will be accompanied             I will not participate  	

Do you have any special dietary requirements?	
No         Yes  Details:	

During the Conference, I will stay at the Intercontinental Hotel     
Alternatively, I can be reached under the following address / tel. / fax #:	

     	

Date:	     		Signature: 	     	

Please submit this form not later than 4 March 2013 by fax or e-mail
Fax:   +43-1 514 36- 6250  	e-mail:    pm-ext-coop@osce.org