REACHING THE UNREACHED 2: REGIONAL MEETING OF SOUTHEAST ASIAN COUNTRIES TO ACCELERATE THE ATTAINMENT OF EDUCATION FOR ALL GOALS 20-21 June 2011 Four Wings Hotel Bangkok, Sukhumvit 26 Road, Bangkok, Thailand REGISTRATION FORM

Please complete this form and affix a clear colored photo of at least 400 x 400 Please attach pixels for the name tag, and return to the SEAMEO Secretariat on or before 13 photo here June 2011 by email: [email protected], cc: [email protected].

PARTICIPANT’S PROFILE Title: Prof Dr Mr Mrs Ms Others (please specify) ______Name: Preferred name for ID card (optional): Sex: Male Female Nationality: Title of Position/Designation: Institution/Organization/Agency: Participant’s Classification

SEAMEO Member Country Official SEAMEO Centre Official International Organization/EFA Partner Representative Others (please specify) ______

Contact Address:

Postcode: Country: Tel No. Fax No. Email: Dietary Requirements: Group hotel reservation has been made for all participants at the Four Wings Hotel Bangkok Address: 40 Sukhumvit Road 26, Klongtoey, Bangkok, 10110 Thailand Tel: (02) 260-2100 Fax: (02) 260-2343 Website: www.fourwingshotel.com

The room rates are nett and inclusive of breakfast. Please indicate the room type required:

[ ] Deluxe (Single) 2,250 Baht [ ] Deluxe (Double) 2,250 Baht

Period of stay: Check-in date: ______Check-out date: ______

If you wish to share room with another participant, please indicate name: ______

FLIGHT DETAILS Arrival in Bangkok Date: ______Time: ______Flight No. ______From: ______Departure Date: ______Time: ______Flight No. ______To: ______Other relevant information: