ADPC REGIONAL TRAINING WORKSHOP on WRF APPLICATION FORM
September 24-28, 2012
Vietnam Institute of Meteorology, Hydrology and Environment (IMHEN)
Hanoi, Vietnam
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For more information: Senaka (senaka_basnayake@adpc.net) or Susantha (susantha@adpc.net)
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Application Date:
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Personal
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Title: *
First Name: *
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Last Name: *
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Name as to appear on the training certificate: *
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Date of Birth:
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Passport Number: *
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Contact Tel: *
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Home Address:
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Organization Information
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Organization Name: *
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Organization Address:
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Emergency Contact Information
Name and address of person to contact in case of emergency: *
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Relationship:
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Other Information
English Language Proficiency:
Intended WRF Usage:
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WRF Knowledge:
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Linux/Unix Knowledge:
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Arrangements for Medical Care:
(Accepted participants will be responsible for any medical expenses they may incur while in Vietman, and should consider arranging insurance before joining the course; Training Organizers will not be responsible for any medical expenses during the training. Please indicate if you are in good health.)
Payment
Account Name: Asian Disaster Preparedness Center (ADPC)
Account Number: 029-1-11600-0
Bank Address: Kasikorn Bank, Sanampao Branch, 1019/18 Phaholyotin road, Samsen Nai, Phayathai, Bangkok, Thailand
Swift code: KASITHBK, Thailand
Note: Please include participant’s name in the “Originator to Beneficiary Information (OBI) section of the wire transfer form. Personal cheque and credit card are not acceptable.
Payment of Fee is Settled by:
Payment Date: *
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Fees are expected to be transferred to ADPC at least 15 days in advance.
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Access to Training Information
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Declaration
I certify that the above statements are true and accurate to the best of my knowledge. If selected, I undertake to:
a. Fully attend all scheduled study activities
b. Refrain from political, commercial or any activities other than those covered by my study program.
c. Submit reports in accordance with the arrangements made by my employer or sponsoring agency.
d. Return to my home country at the end of the fellowship.
e. Be fully responsible for any medical expenses while undergoing training.
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