| *Participation Position: |
|
| With/without Invitation Letter: |
|
| Full Name: |
|
| Affiliation/Institution/Firm: |
|
| Date/Place of birth or Age: |
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| Institution/home address: |
|
| Qualifications/degrees/status: |
|
Short biography,
field of project/culture/commerce: |
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Competence in foreign languages
(written/spoken): |
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| Date of arrival/duration of stay: |
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Special Experience
(fieldwork/observation in Aceh Sumatra/ASEAN): |
|
Proposed presentation programme, including:
1. Subject of interests:
2. Special units to be visited (with duration of stay);
Material, facilities/stands or equipment needed;
Names of persons/companies the visitor would like to meet: |
|
Subject of proposed lectures,
reports on conferences: |
|
| Other suggestions apart from the programme: |
|
| Accompanying person/s: |
|
|
|
| |
form |
(*Participation position, e.g. as: Speaker, Sponsor, Partner, Presenter, Volunteer, etc.)
