REGISTRATION FORM:                                        ICEVI West Asia Regional Conference Dhaka, Bangladesh    
Event Timing: February 28-29, 2024
Event Address: The Krishibid Institution of Bangladesh (KIB), Farmgate
Contact us at: ICEVI.Dhaka2023@gmail.com, Tel: +(880-2) 55010240 
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A. Personal Information:
Full Name of the Participant *
Name in short
Date of Birth *
MM
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Sex *
Required
B. Contact Information:
Designation
Organization
Address
Phone *
Email *
Website
C. Disability-Related Information: 
Type of disability
If you use any aids and/or appliances, please provide the details 
If you require any special needs services and/or special assistance, please provide details

If a personal attendant will accompany you, please provide the details:

(Note: Any additional companion/s, apart from personal attendant, will need to register individually)
  Name of Assistant

Sex of Assistant

D. Health Related Information:

 *
If you have any health/medical condition whatsoever, which you feel the organizers should be aware of, and be prepared for, please provide the details:

 *

E. Food/Diet Related Information:

If you have any food/dietary reservations/restrictions, please provide the details:

If you have any food/dietary allergies whatsoever, which you feel the organizers should be aware of, and be prepared for, please provide the details:

F. Information Regarding Mode of Participation for International Participants:

 

How do you plan to join the conference sessions  (For International Participants)

G. Accommodation Related Information (for participants coming from abroad):

Do you want the organizers to arrange accommodation for you during the event, on your behalf (For International Participants)

Would you be willing to share your room with other participants? (For International Participants)

H. Language-Related Information (for participants coming from abroad):

If you would prefer simultaneous interpretation of the proceedings of all working sessions in any international language other than English, in which international language would you prefer the interpretations  (For International Participants)

Passport Related Information (for participants coming from abroad)


Nationality

Passport Number
Date of Issue (Passport)
MM
/
DD
/
YYYY
Date of Expiry (Passport)
MM
/
DD
/
YYYY

Place of Issue

Place of Birth

Method of Payment of Registration Fees
In-country participants are strongly advised to submit their completed Registration Forms and pay the specified amount of Registration Fees directly at the conference Secretariat. A Money Receipt will be handed over immediately upon submission of the fees.

For Bank Transfer 
Bank Name: Dutch-Bangla Bank Ltd,
Bank Address: Ring Road Branch, Shyamoli, Dhaka 1207, Bangladesh
Account Name: CSID-ICEVI CONFERENCE PROJECT
Current Account Number: 148.110.0049098
Routing Number: 090263978
Swift Code Number: DBBLBDDH
For any communication, or queries, please contact:
Dr Nafeesur Rahman
Executive Secretary, Conference Committee
CSID
House # 676, Flat # 1A, Road # 13
Baitul Aman Housing Society,
Dhaka – 1207, Bangladesh

Tel: +(880-2) 55010240
E-mail: ICEVI.Dhaka2023@gmail.com
Website: www.csid-bd.com
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