EPSU Circular LC No 51 (2015)
EPSU Local and Regional Government
Social Dialogue Plenary Meeting
2 December 2015
Brussels, Thon City Centre
PARTICIPATION FORM
FAMILY NAME ........................................................................................................................................
FIRST NAME ...........................................................................................................................................
UNION .....................................................................................................................................................
COUNTRY ...............................................................................................................................................
E-MAIL ....................................................................................................................................................
DATE OF BIRTH ....................................................................................................................................
PASSPORT / ID NUMBER .....................................................................................................................
Participation:
☐ I will participate
☐ I will NOT participate
Accommodation: EPSU does not make hotel booking for participants.
Please see hotel list here http://www.epsu.org/a/11078
Interpretation (TBC):
Active: English – French – German – Spanish – Italian – Swedish
Please note that when interpretation has been arranged especially for you, and you are unable
to participate in the meeting, that you must inform the secretariat.
IF REQUIRED FOR VISA PURPOSES ONLY
Passport details:
Birth date.. . . . . . . . . . . . . . . . .
Place of birth . . . . . . . . . . . . . . . .
Nationality: . . . . . . . . . . . . . . . .
Passport N°. . . . . . . . . . . . . . . . .
Date and place of issue . . . . . . . . . . . . . .
Date of expiry: . . . . . . . . . . . . . .
To be returned by 18 November 2015 at the latest to:
EPSU Secretariat
jprairial@epsu.org