APPLICATION FORM

1

AFHR 2015

ASEAN STUDENTS’ FORUM ON HUMAN RIGHTS 2015

APPLICATION FORM PERSONAL PARTICULARS

Family Name/Last Name

Given Name

Date of Birth (DD/MM/YYYY)

Gender

Blood Type Religion Nationality Passport Number

e-mail address Passport Expiry Date

Current Address

Telephone Number (with country code)

Mobile

Landline/Home

ORGANIZATIONAL DETAILS

Country Academic year Faculty & University

IMPORTANT REQUESTS

Allergies Special Request in your food (Vegetarian/Halal/Other)

Medical Complications

EMERGENCY CONTACT

Name - Contact person

Relationship

APPLICATION FORM

2

Address

Contact Number with country code

EMERGENCY CONTACT II Name - Contact person

Relationship

Address

Contact Number with country code