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UNECE€¦ · Web viewSAFETY AT UNIVERSITIES REGISTRATION FORM Armenia (Yerevan), 26 March, 2013...

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INTERNATIONAL WORKSHOP on the project ASSISTANCE TO RAISING KNOWLEDGE ON INDUSTRIAL SAFETY AT UNIVERSITIES REGISTRATION FORM Armenia (Yerevan), 26 March, 2013 Please complete and return this form before 28 February 2013 to: and a copy to: “Eco Peace” scientific, ecological NGO Sheram str. 111, apt. 24, 0034 Yerevan, Armenia Kristine Sahakyan Tel: (+374 91) 52 93 27 E-mail: eco-peace @ rambler.ru Federal Ministry for the Environment, Nature Conservation and Nuclear Safety UBA, Z6, Wörlitzer Platz 1, 06844 Dessau Gerhard Winkelmann-Oei Tel: +49.340.2103.3298 E-mail: [email protected] Participant of Country, institution/organization Division, your position Participant Family Name First Name Mr. Mrs. Ms. Date of Birth (DD/MM/YYYY) Address of the institution/organization (in full): Home address (in full): Phone number:
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Page 1: UNECE€¦ · Web viewSAFETY AT UNIVERSITIES REGISTRATION FORM Armenia (Yerevan), 26 March, 2013 Please complete and return this form before 28 February 2013 to: and a copy to: “Eco

I N T E R N A T I O N A L W O R K S H O Pon the projec t

ASSISTANCE TO RAISING KNOWLEDGE ON INDUSTRIAL SAFETY AT UNIVERSITIES

R E G I S T R A T I O N F O R MArmenia (Yerevan), 26 March, 2013

Please complete and return this form before 28 February 2013 to: and a copy to:

“Eco Peace” scientific, ecological NGOSheram str. 111, apt. 24, 0034 Yerevan, Armenia

Kristine SahakyanTel: (+374 91) 52 93 27 E-mail: eco-peace @ rambler.ru

Federal Ministry for the Environment, Nature Conservation and Nuclear Safety

UBA, Z6, Wörlitzer Platz 1, 06844 DessauGerhard Winkelmann-Oei

Tel: +49.340.2103.3298E-mail: [email protected]

Participant of Country, institution/organization

Division, your position

Participant Family Name First Name

Mr.

Mrs.

Ms. Date of Birth (DD/MM/YYYY)

Address of the institution/organization (in full):

Home address (in full):

Phone number:

E-Mail address:

Page 2: UNECE€¦ · Web viewSAFETY AT UNIVERSITIES REGISTRATION FORM Armenia (Yerevan), 26 March, 2013 Please complete and return this form before 28 February 2013 to: and a copy to: “Eco

Describe the motivation for your participation

Date Signature

Language Preference English Russian


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