Global Standards Symposium
&
World Telecommunication Standardization Assembly (WTSA-08)
Johannesburg, South Africa, 20 – 30 October 2008
Please return to:
ITU/BDT
Geneva (Switzerland)
E-mail : bdtfellowships@itu.int
Tel: +41 22 730 5487
Fax: +41 22 730 5778
Request for a partial fellowship to be submitted before 29 August 2008
Participation of women is encouraged
Country
_____________________________________________________________________________________________________
Name of the Administration or Organization
Mr. / Ms.
.
_______________________________________________________________________________
_______________________________________________
(family name)
_______________________________________________
(given name)
Title _________________________________________________________________ ___________________________________________________
Address ________________________________________________________________________________________________
__________________________________________________________________________________________________
Tel.:
__________________
Fax: __________________
E-Mail __________________
PASSPORT INFORMATION :
Date of birth
_______________________________________________
Nationality
__________________________________
Date of issue
________________
In (place)
Passport number
____________________________
_______________________________________
Valid until (date)
CONDITIONS OF THE PARTIAL FELLOWSHIP
1. Accommodation is booked and pre-paid by ITU
2. A daily allowance to cover meals and misc. expenses will be paid to the fellow
3. Cost of airticket will be covered by fellow’s Administration
4. Imperative that fellows be present from the first day to the end of the meetings.
Signature of fellowship candidate
Date
TO VALIDATE FELLOWSHIP REQUEST, NAME, TITLE AND SIGNATURE OF CERTIFYING OFFICIAL DESIGNATING
PARTICIPANT MUST BE COMPLETED BELOW WITH OFFICIAL STAMP.
Signature
Date
__________________