REGISTRATION FORM

SECOND INPIM CAPACITY BUILDING PROGRAM

IZMIR/MENEMEN, TURKEY

June 18-29, 2006

I. Participant Details: (write in capital letters)
Title	Dr. Mr Ms					Gender		Male Female
Last Name					First Name					Middle Initial
Passport No			Issuing Country					Place of Issue
Date of Birth			Date of Issue					Date of Expiry
Designation							Organization
Address							City
State				Country				ZIP Code
Office Phone		Home Phone					Fax		Email
Please rate your English language ability: Basic Intermediate Advanced

II. Institution type: (please tell us about your institution where you come from)
Water Users Association	Development Bank	Multilateral Agency (UN, FAO)
Central/State Govt Agency or Ministry	Media	University
Training Institute	Research Institute	NGO/non-profit organization

III. Purpose of attending the Capacity Building Program:

	IV. Payment Details: Seminar Fee US $ 2400/-
	Mode of Payment: Wire Transfer Please note the wire transfer details will be made available upon request. Send an email to svasenda@inpim.org or info@inpim.org. All wire transfers must contain the message. Please specify your name and include “Second International PIM Capacity Building Program” in the wire message.
Wire Transfer No		Date of Transfer
Name of the Bank		Amount Transferred	US $

IV. Travel Details: Arrive no earlier than the afternoon of December 5 and stay no later than the Afternoon of December 14
Date of Arrival	Flight No	FLT. NO	Airline	Airline	Time	Time AM/PM
Date of Arrival	Flight No	FLT. NO	Airline	Airline	Time	Time AM/PM
Please send your completed application to: INPIM, 333 ½.Pennsylvania Avenue SE, Third Floor, Washington, DC 20003, USA. Telephone: +1 202-546-7005; Fax + 1 202-318-0215. Email: coordinator@inpim.org; or info@inpim.org Internet: www.inpim.org