Bi-Annual Member Meeting Registration Form
When: November 21-22, 2019

Where: Diakonia Center (Known as ICF)
Address: #19-21, st. 330, Boeung Keng Kang 3, Phnom Penh, Cambodia
Language: English and Khmer (simultaneous translation)

Instructions: Please have everyone at your organization who plans on attending Member Meeting complete this form at least 5 days before the event.

One person may complete this form on behalf of multiple people in their organization (with their permission). To do this, click the 'Submit another response' link after finishing the survey the first time to register someone else.

Purpose: To track attendance at Chab Dai Member Meeting

More Info:
- General Information: Ms. Sorn Nary I sorn.nary@chabdai.org , Tel: 012 385 283.
- Booking Booth: Mr. Yan Yamath I yan.yamath@chabdai.org , Tel: 092 911 092
- Payment: Hem Sinoch I sinoch.hem@chabdai.org, Tel: 012 000 999

Attendance Fee: $10 for one ticket/day.
[Please pay at the Registration Table at the Member Meeting.]
Email address *
Phone *
Your answer
Participant Last Name *
Your answer
Participant First Name *
Your answer
Gender (M/F) *
Which sector do you work in? *
Are you a Chab Dai Coalition Member? *
If you are a Chab Dai Coalition Member, please select your organisation name: *
If you are not a coalition member, please write your full organisation name:
Your answer
Participant Position *
Is this your first time attending a Coalition Member Meeting? *
Have you attended another Coalition event (i.e. training, forum, etc.) before? *
Please select your attendance on Day 1:
Please select your attendance on Day 2:
Please select your payment preference: *
Cash
Cheque
Chab Dai Staff
Butterfly Project's Attendee
Speaker
Pay at Event
Submit
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