Registration Bucharest IPU Seminar

Fourth IPU Global Conference of Young Parliamentarians A place for everyone: Young Parliamentarians as drivers of inclusion Ottawa, Canada, 17-18 November 2017

One form per participant Registration Form

Country

Personal Title Mr.  Mrs.  Ms.  First Middle (if any) Surname Name

Date of Birth (dd/mm/yyyy) Parliament (Chamber)/ Organization Member of Parliament  Senator  Aide or staff  Function Other  :

Full title

Type of Passport Diplomatic  Official  Ordinary  Other  :

Passport No. Nationality

Office e-mail Address

Personal e-mail Address Date of arrival and flight number Date of departure and flight number

Telephone: Fax:

Date: Signature: Please return this form to the addresses below no later than 29 September 2017.

Inter-Parliamentary Union Parliament of Canada Chemin du Pommier 5 131 Queen Street 1218 Le Grand-Saconnex Ottawa, Ontario Geneva, Switzerland K1A 0A6, Canada Telephone: +41 22 919 41 50 Tel.: +1 (613) 943-2733 Fax: +41 22 919 41 60 Fax: +1 (613) 995-0212 Email: [email protected] E-mail: [email protected]