<p> Fourth IPU Global Conference of Young Parliamentarians A place for everyone: Young Parliamentarians as drivers of inclusion Ottawa, Canada, 17-18 November 2017</p><p>One form per participant Registration Form</p><p>Country</p><p>Personal Title Mr.  Mrs.  Ms.  First Middle (if any) Surname Name</p><p>Date of Birth (dd/mm/yyyy) Parliament (Chamber)/ Organization Member of Parliament  Senator  Aide or staff  Function Other  :</p><p>Full title</p><p>Type of Passport Diplomatic  Official  Ordinary  Other  :</p><p>Passport No. Nationality</p><p>Office e-mail Address</p><p>Personal e-mail Address Date of arrival and flight number Date of departure and flight number</p><p>Telephone: Fax:</p><p>Date: Signature: Please return this form to the addresses below no later than 29 September 2017. </p><p>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] </p>