Resilient Cities Asia-Pacific 2015 - Registration Form
Thank you for your interest in Resilient Cities Asia-Pacific 2015 congress, in Bangkok, Thailand, 11 - 13 February 2015.The contribution cost towards Congress is:
City representatives, NGOs, International agencies - USD 250
Commercial Organisation - USD 350
The registration fees can be paid through cash or cheque/demand draft made out to ICLEI South-Asia.
Registration information includes contact information about you and your organization or local government.
The Resilient Cities Asia-Pacific Congress Team will then process your registration, which will take 2-5 business days.
*Required
Ms./Mr.
*
Choose
Ms.
Mr.
Prof./Dr.
Choose
Prof.
Dr.
First Name
*
Your answer
Last Name
*
Your answer
Job Title/Function
*
Your answer
Department
e.g. Environment Department
Your answer
Division
e.g. Low Carbon Development Team
Your answer
Organisation name (in English)
*
e.g. Bangkok Metropolitan Administration
Your answer
Organisation name (in original language)
Your answer
Type of organisation
*
Local government
Regional government
Municipal utility
Local or regional government association
National government
International organisation
Finance institution
Academia/Research
NGO
Private sector
Media
Other:
Street Address
*
Your answer
City
*
Your answer
Zip/Postal Code
Your answer
State/Province/Region
Your answer
Country
*
Your answer
Phone Number
*
Please enter the following format: +91 11 4106 7220
Your answer
Fax Number
Please enter the following format: +91 11 4106 7221
Your answer
E-mail Address
*
Your answer
Web
Your answer
Dietary Requirements
*
Vegetarian
Non-vegetarian
Halal Meal
Kosher Meal
Other:
Required
Please list any special requirements that you might have:
Your answer
Only for Indian Passport holders: Does your Passport have 3 blank pages?
Yes
No
Only for Indian Passport holders: What is the expiry date of your passport?
Your answer
Remarks
Your answer
Notifications
I would like to subscribe to ICLEI South Asia's eNews mailing list
I would like to receive information about ICLEI Membership
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