Registration form

THIRTY-SIXTH ORDINARY SESSION OF THE AFRICAN COMMISSION ON HUMAN AND PEOPLES’ RIGHTS
23rd NOVEMBER to 7th DECEMBER, 2004

PALAIS DES CONGRES, LE MERIDIEN PRESIDENT HOTEL,
Pointe des Almadies, DAKAR, SENEGAL
Tel: (221) 869 6969; Fax: (221) 869 6924

PRELIMINARY REGISTRATION FORM

IMPORTANT
This form should reach the Secretariat of the ACHPR by 25th October, 2004

A. General Information

Name: (IN CAPS)……………………………………………………………………………………………….

Designation: ……………………………………………………………………………………………………..

Organization: …………………………………………………………………………………………………….

Address: …………………………………………………………………………………………………………….

Telephone: …………………………………. FAX: ………………………………………………………..

E-mail: ………………………………………. P.O. Box: ………………………………………………..

B. Personal Details :

Passport No.: ……………………………. Place of issue: ……………………………..

Date of Issue: ……………………………. Expiry Date: ………………………………….