WMO SYMET-XI Registration Form

The 11th WMO Symposium on Education and Training
                      New Approaches to the Education and Training of
                          Meteorological and Hydrological Forecasters

                 (Citeko, Indonesia, 25-29 October 2010)

         Participant Nomination Form

________________________________________________________________________________

The Permanent Representative of

(Please select)

with WMO nominates the following candidate to participate in the above Symposium.

________________________________________________________________________________

Section One – Personal details

1)- Title:

FAMILY NAME:

Given Name:

2)- Gender:

3)- Email:

4)- Telephone:

5)- Telefax:

6)- Official Address:

7)- Name, Address and Telephone of the person to be notified in case of emergency:

8)- Languages: (English)

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(French)

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(Russian)

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(Spanish)

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9)- Upload your photo here

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Section Two – Participant position and duties

10)- Where do you work?

11)- What is your job title?

12)- How long have you been in this position?

13)- What is your qualification?

14)- What is your main role(s)?

15)- If you are from a training center/institution,

what courses are offered?

16)- Why do you want to attend this symposium?

17)- How will attending this symposium make a difference to your training institution?

Section Three – Details for entry visa purposes

For more information, please visit the Website of the Embassy of Indonesia at:
http://www.embassyofindonesia.org/consular/visitvisa.htm

18)- Do you need entry visa for Indonesia?

19)- Date of birth:

20)- Place of birth:

21)- Nationality:

22)- Passport Number:

23)- Place of issue:

24)- Date of issue:

25)- Valid until:

26)- Place where you will apply for Indonesian entry visa:

________________________________________________________________________________

Section Four – Financial Assistance

In view of the limited available funds, your service is expected to fund your participation. However, if this is not possible, a request for limited financial assistance can be indicated on the participant nomination form. These requests will be considered within the limited funds available for the seminar.

27)- Is financial assistance requested?

28)- If financial assistance requested, please specify:

(*) If travel is requested, estimated cost of cheapest return air ticket in USD:

Section Five – Statements

29)- Statement by the nominee:

30)- If you wish to contribute, please select the theme you wish to present:

31)- Type or paste the title and abstract (**) of the presentation you wish to make below (limited to 500 words). You may submit in English, French, Russian or Spanish, but English is preferred. (Note: due to schedule constraints, only a limited number of submissions can be presented in plenary. You may be asked to offer your presentation in a poster session or to consider alterations to the proposed content of your presentation for it to fit better with the Symposium themes.

(**) The cut-off date for submission of abstracts is 13 August 2010. For more information regarding paper presentation, please refer to Annex-III of the circular letter ETR/SYM-110 of 4 May 2010.

Place: _______________________ Date: _______________________________

Signature of the Nominee: ________________________________________________

32)- Statement by the Permanent Representative (PR) of the country with WMO on how the skills and knowledge gained through attending the symposium will be applied within the NMHS or training institution:

Place: _______________________ Date: _______________________________

Name and Surname of the PR with WMO: _____________________________________

Signature of the PR with WMO: _____________________________________________

IMPORTANT..!

1)- Click the "Print Form" button below to print your nomination form; sign the nomination form; have it signed by the Permanent Representative of your country with WMO; and returned it at the latest by 13 August 2010 to:

Secretary-General
World Meteorological Organization
7 bis, avenue de la Paix, Case postale No. 2300
CH-1211 GENEVA 2, Switzerland
Fax No: +41 22 730 80 41 or +41 22 730 81 81

2)- Click the "Submit Form" button after printing your nomination form.