63Rd Commonwealth Parliamentary Conference

63rd Commonwealth Parliamentary Conference

Dhaka, Bangladesh

01 – 08 November 2017

BIOGRAPHICAL DETAILS FORM

Conference Registration is now open, please register online at Branches unable to register online are requested to return the completed form to the Bangladesh CPC Cell with an electronic passport photograph by 30 August, 2017 to:

CPA SECRETARIAT: / CPA BANGLADESH BRANCH:
Email:
Fax: (+44 20) 7222 6073 / Email:

Fax: +88 02 8171451, +88 02 9122216

Completion of this Form indicates that you agree to the information provided being published in the Biographies Booklet provided to all participants to the conference. Please note that there is a limit of 250 words for each section.

Name (Capital letters please):

First Name:
Surname:
Title:
Parliamentary Abbreviation/Decorations:
CPA Region / CPA Branch / Office held in CPA Branch – if any
(e.g. President, Member of the Executive Committee)
Category:
Delegate
/ Secretary
Exco Member
/ CWP Steering Committee

Regional Secretary
/ Observer
Guests
/ SOCATT
Electronic Passport Photo (Jpeg):
An electronic passport sized photo of Delegate
Electronic passport photo attached
Photo will be used for your ID card and the biographies booklet
Date of Birth: / Gender: Male Female
Day: Month: Year:
Year first elected to Parliament:
Political Party (Please give full name):
Present Portfolio/Office, if any e.g. Minister, Leader of Opposition
Education:
Interests:
Previous CPA Conferences, Seminars, Workshops attended:
Name Badge: Please indicate how you wish your name to be printed on your name badge:
Dietary Preference: / Vegetarian: Non-vegetarian: Others:
Spouse/partner’s Detail (if accompanied):
Full Name (Capital letters please):
Name Badge:
Gender:
Date of Birth:
Diet: Vegetarian/ Non-vegetarian/Other
Electronic Passport Photo of Spouse/partner (if accompanied) in Jpeg format:
An electronic passport sized photo of spouse/partner (if accompanied).Electronic passport photo attached
Spouse/partner’s Payment Detail (if accompanied):
Payment Date:
Bank Name:
Country:
Reference No:
Amount (USD):

Signature:......

Date:......