Request for Visa Invitation Letter for Int'l Travel

Visa Invitation Letter Request Form
Applicant Information
Full Name (as shown on passport):*

First NameMiddle NameLast Name
Preferred Name (optional):

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Nationality/Citizenship:*
Passport Number:*
Contact Information
Email Address:*
example@example.com
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Meeting Information
Meeting/Event Invitation Needed For:*
If other, name of meeting:*
Are you registered for the meeting?*

YesNoIn Process
Registration ID/Confirmation Number:*
Participation Details
Will you be presenting?*

Yes - Oral presentationYes - PosterNo - Attendee only
Presentation Title:*
Visa Information
Country where visa will be applied for:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
U.S. Embassy or Consulate location:*
Invitation Letter Details
Name that should appear on invitation letter:

PrefixFirst NameMiddle NameLast NameSuffix
Letter needs to be addressed to:*
(Exact name of U.S. Embassy/Consulate)
Embassy/Consulate Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Additional Requests
Do you need any specific wording for your visa application?
Disclaimer/Agreement
Type a question*

I understand that this invitation letter is issued solely to assist with visa application purposes and does not guarantee visa approval or financial support from ISSWSH.
My signature in agreement with the above disclaimer/agreement*
Should be Empty:

Visa Invitation Letter Request Form

Applicant Information

Contact Information

Meeting Information

Participation Details

Visa Information

Invitation Letter Details

Additional Requests

Disclaimer/Agreement