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SEAMEO Regional Centre for History and Tradition
ANNUAL PROGRAMMEStudy of Mon Society and Culture
REGISTRATION FORM
Please print and return this form to : SEAMEO Regional Centre for History and TraditionPyay Road, Yangon, 11041, MyanmarFax: 95-01-515175E-mail: <[email protected]>< [email protected]>
__________________________________________________________________________________________
I wish to register for the Study of Mon Society and Culture programme to be conducted from 18 to 24 March 2015.
Please tick the appropriate one.
Title: Prof. Dr. Mr. Mrs. Ms. others (Please specify) __________________________
First name: _________________________________________ Middle name: ___________________________
Last name: _________________________________________ Father’s name: __________________________
Sex: Male Female
Citizenship: _________________ Date of Birth: _____________________ Place of Birth: _______________
Passport No: _________________________ Date of issue: ________________________________________
Date of expiratory: ___________________ Place of issue: ________________________________________
Designation:_______________________________________________________________________________
Academic qualification: ______________________________________________________________________
Institution/ Organization: _____________________________________________________________________
__________________________________________________________________________________________
Contact Address:____________________________________________________________________________
City: ______________________________ Post Code____________________ Country : __________________
Telephone no. Office : _______________________________ Residence : ______________________________
Fax : ___________________________________ E-mail : __________________________________
Name:_________________________________
Signature:_______________________________
( NOTE: Registration deadline is 4 February 2015)
