Dialogue on Just Governance 2016: Application Form
Initiatives of Change, Asia Plateau, Panchgani, India
Personal Details
Title *
Last Name *
(According to your passport or equivalent travel document)
Your answer
First Name *
(According to your passport or equivalent travel document)
Your answer
Middle Name
(According to your passport or equivalent travel document)
Your answer
Gender *
Country *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
City *
Your answer
Post Code *
Your answer
Phone Number
country code, area code, phone number
Your answer
Mobile Number *
country code, area code, phone number
Your answer
E-mail address *
Your answer
Profession *
Your answer
Organisation *
Your answer
What would you like the dialogue participants to know about you? *
No more than 200 words
Your answer
How may we share the above information *
Meal preferences
Do you have any allergies?
Your answer
Dialogue and Workshop Participation Details
The dialogue will be in english. If you need translation, please specify the language. We will try and provide translation where possible.
Your answer
Please tick the events you will attend *
Required
Which region of the world or issues are you particularly concerned about and why? What are your hopes for your time at the dialogue? *
Your answer
How did you hear about the dialogue? *
Your answer
How many days will you stay? *
A contribution of US$ 60 or ₹ 3000 per day will cover the costs of your participation in the dialogue. Any additional contribution will help subsidise those who are not able to cover full costs. Indian participants have the option of paying either in cash or by cheques drawn in favour of 'Friends of Moral Re-Armament (India)', foreign participants will need to pay in cash, on arrival.
Passport or Equivalent Travel Document Details (for non Indian passport holders only)
This information will be used to issue letters required for your Indian visa application.
Passport Number or Number of Equivalent Travel Document
Your answer
Place of Issue
Your answer
Passport/Equivalent Travel Document Expiry
MM
/
DD
/
YYYY
Visa Number
If you already have an Indian Visa
Your answer
My Country of Origin *
Your answer
Nationality *
Travel Details
Please give us as much information as you can about your travel plans. We do understand that there might be some changes when you make actual bookings. You can update us via email at secretariat@justgovernance.org once your bookings are confirmed.
Travel Options:
The closest ports of arrival to Asia Plateau are Mumbai or Pune. Closer the time we will provide you with all the necessary travel information you will need to travel from the airport/train station to Asia Plateau. If you have already booked your tickets, please fill out the details below.
City of Arrival
Your answer
Flight/Train No.
Your answer
Arrival Date
MM
/
DD
/
YYYY
Arrival Time
Time
:
City of Departure
Your answer
Flight/Train No.
Your answer
Departure Date
MM
/
DD
/
YYYY
Departure Time
Time
:
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms