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JOINT CHEMICAL, BIOLOGICAL, RADIOLOGICAL AND NUCLEAR DEFENCE CENTRE OF EXELLENCE

Víta Nejedlého 3, 682 01 Vyškov, Czech Republic

REGISTRATION FORM Lecturers Choose an item.

1. Instructions

ALL REQUESTED INFORMATION IS MANDATORY!

Submit this registration form in PDF format NLT 6 weeks before the course starts to the Project Manager via E-mail or FAX 00 420 973 452 800

ALL INFORMATION WILL BE USED FOR JCBRN COE INTERNAL PURPOSES ONLY!

2. Basic information
Name of the Course Choose an item.:
a. Family Name: Enter text. / b. Given Name: Enter text.
c. Gender: Choose an item. / d. Date of Birth Day Month Year
e. NATO Rank/Grade: Choose an item. / f. Nationality: Choose an item.
g. Passport No. (ID*): Click here to enter text.
h. Duty Phone: Click here to enter text. / i. Cell Phone: Click here to enter text.
j. E – mail address: Click here to enter text.
k. Your Supervisor’s E-mail address: Click here to enter text.
l. Organization Click here to enter text. / m. Postal Address of the Organization
n. Department Click here to enter text. / P.O. BOX/Street: Click here to enter text.
o. Post/Function Click here to enter text. / Postcode/City: Click here to enter text.
p. Security Clearance: Choose an item. / Country: Click here to enter text.
3. Arrival & Departure
a. Date of Arrival: Day Month Year / b. Date of Departure: Day Month Year
Time of arrival: Click here to enter text. / Time of Departure: Click here to enter text.
4. Accommodation
a. Military Accommodation Choose an item. / b. Hotels (booking is participants’ responsibility)
Number of nights: Click here to enter text. / Accommodated in (recommended): Choose an item.
Parking in barracks Choose an item. / Other hotel: Click here to enter text.
Vehicle Reg. Plate Click here to enter text. / Daily transfer from/to hotel: Choose an item.
Residential Address*: Street, No.: Click here to enter text.
Postcode, City: Click here to enter text.
5. Others
a. Letter of invitation: / Choose an item.
b. Dietary request: / Click here to enter text.

*only for Czech participants accommodated in military dormitory

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