Asia-Pacific Regional Forum on Mainstreaming ICT Accessibility 25th - 27th August 2009 Bangkok, Thailand

		Asia-Pacific Regional Forum on Mainstreaming ICT Accessibility for Persons with Disabilities 25th  - 27th August 2009 Bangkok, Thailand
Please return to:			Planning, Budget and Administration (PBA) ITU/BDT Geneva (Switzerland)		E-mail : bdtfellowships@itu.int Tel: +41 22 730 5487 / 5095 Fax: +41 22 730 5778
	Request for a fellowship to be submitted before 24th July 2009)
				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                                                                                        ____ Passport number              ______________________                                                                                                                                                                                                                                                                                          Date of issue                                                           In (place)   ____________________________       Valid until (date)
	CONDITIONS 1.     One fellowship per eligible country. 2.     One return ECO class airticket by the most direct/economical route. 3.     A daily allowance to cover accommodation, meals and incidental expense. 4.     Imperative that fellows be present first day/end of the 25th to 27th August 2009. 5.     Due to a limited budget, fellowships will be awarded on a priority manner to Least Developed Countries (LDCs) and Low-income Developing Countries respectively and first-come-first serve basis. 6.     Applicants who have direct or relevant responsibility to subjects of the conference will be highly considered.
	Signature of fellowship candidate                                                                                                            Date ______________
	TO VALIDATE FELLOWSHIP REQUEST, NAME AND SIGNATURE OF CERTIFYING OFFICIAL DESIGNATING PARTICIPANT MUST BE COMPLETED BELOW WITH OFFICIAL STAMP.       Signature:___________________________________________________Date:_____________________________________

 

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