IFCS Database Contact Form 7 August 2007 INTERGOVERNMENTAL FORUM ON CHEMICAL SAFETY (IFCS) ( ) Please add me to the IFCS mailing list Please indicate language of preference (1 st and 2nd choice) Language: Arabic__ Chinese__ English__ French__ Spanish__ Russian__ PLEASE TYPE OR PRINT CLEARLY IN CAPITALS AND IN BLACK Family Name: _______________________________ (Prof/Dr/Mr/Mrs/Ms) First Name: ___________________________________________________________________ Job Title/Position: ___________________________________________________________________ Organization: ___________________________________________________________________ Please select one option: I am a government Official: I represent an Intergovernmental Organization: I am affiliated with an International Non-governmental Organization: If yes, please specify;_________________________________________ _____ ______ I am none of the above, please specify: Full mailing address: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ City: ______________________ State/Province etc: ________________________ Postal Code: ________________ Country _______________________________ For telephone and fax numbers, please indicate country and city codes Telephone: _____________________________Fax: ________________________ E-mail address: ___________________________ Website: ___________________ EMAIL, FAX OR MAIL THIS FORM TO: IFCS Secretariat (L430) c/o World Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland Fax: + 41 (22) 791 4875 Email: ifcs@who.int Secretariat: c/o World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland Tel: +41 (22) 791 3873/1334; Fax: +41 (22) 791 4875; Email: ifcs@who.int; Website: www.ifcs.ch