ANNEX 1

ANNUAL SECURITY REVIEW CONFERENCE

Vienna, 19 – 20 June 2013

Registration Form

Please submit this form not later 7 June 2013 by e-mail to elke.lidarik@osce.org

SECTION 1

Please complete in capital letters

Family Name:	Ms.		Mr.		Given Names:	
     	     	

Representing:	
Country/Name of Organization/Name of Institution:

Please tick one of the categories below:
 Participating State             Partner for Co-operation         International Organization     
 OSCE Secretariat             OSCE Field Operation             OSCE Institution       
 Other:      	

Title / Position as to appear on the list of participants:	
     	

Tel No. with all prefixes, including national code:	E-mail address:	
     		          	

SECTION 2
		
Nationality	Current country	Date of birth	
	of residence	Day	Month	Year	
     	     	     	     	     	
Passport number	Issued on and by	Passport type	Expiry date	
		Diplomatic	National	Other	Day	Month	Year	
     	     							
Arrival 	Flight #:	     	Departure 	Flight #:	     	
Date: 	     	Time:	     	Date:	      	Time: