4th High-Level Dialogue on Financing for

Development in Asia and the Pacific

28-29 April 2017
Bangkok, Thailand

Registration Form
(Please type or print clearly in English)

Name (Mr.) _________________ ________________ __________________

(First Name) (Middle Name) (Last Name/Surname)

Nationality: _______________ Date of birth: Day_______ Month_______ Year________

Present position: ______________________________________________________________

Office address: ______________________________________________________________

____________________________________________________________________________ _

Phone: ______________________________ Mobile: _________________________________

E-mail: ______________________________ _ Office fax: ______________________________

Passport number: ________________________ Place of issue:________________________ __

Date of issue: __________________ __ Date of expiry: ____________________________

Contact information of secretary/personal assistant (if applicable)

Name: _____________________

Phone: _____________________ Mobile: __________________ E-mail: __________________

Please return your completed registration form and passport copy, preferably by e-
mail, to:

Ms. Patchara Arunsuwannakorn (Email: arunsuwannakorn@un.org: Tel:+66 2288 1245),

with a copy to
Mr. Zheng Jian (Email: jianz@un.org, Tel: +66 2288 1549)