INDIGENOUS PEOPLES INTERNATIONAL SUMMIT ON SUSTAINABLE DEVELOPMENT
Kimberly, South Africa, 20-23 August 2002

Registration Form

  1. LAST NAME:

  2. FIRST NAME:

  3. PASSPORT NO:

  4. BIRTHDATE

  5. NATIONALITY

  6. DATE ISSUED:

  7. DATE OF EXPIRY:

  8. ORGANIZATION/NATIONS/PEOPLES YOU REPRESENT:

     

  9. POSITION OR RESPONSIBILITY IN ORGANIZATION/COMMUNITY:

     

  10. ADDRESS:

  11. TELEPHONE:

  12. FAX:

  13. E-MAIL:

  14. WEBSITE (if there is):

  15. TRAVEL ITINERARY: (Please indicate if you plan to attend the wssd in Johannesburg)

TRAVEL ITINERARY
a. Date and time of departure from your country:
b. Which airport:
c. Flight number:
d. Date and time of arrival in Kimberly:
e. date and time of departure from Kimberly:
f. Flight number:
g. Date and time of arrival in Johannesburg:
h. Date and time of departure from johannesburg:
i. Flight number:

  1. WOULD YOU LIKE TO HAVE A HOTEL RESERVED FOR YOU OR WILL YOU DO THIS ON YOUR OWN?

  2. WOULD YOU LIKE TO CONTRIBUTE A PAPER TO THE CONFERENCE?

     

     

  3. WHAT ARE YOUR EXPECTATIONS FOR THE CONFERENCE?

     

     

  4. OTHER PERTINENT INFORMATION YOU WANT TO SHARE:

     

     
Please send by e-mail to:     Priscilla deWet-Fox: barendsegriqua@telkomsa.net or: Victoria Tauli-Corpuz: tebtebba@skyinet.net or vco@skyinet.net or fax to: 27 53 9276925