SFA eR, Conference on Women & Children Abuse,Human Trafficking and Neglect Secretariat Use Only REGISTRATION NO.: CL85639377/USGB-78 ‘You have been duly registered to participate in the forth- coming International Society for Human Rights -ISHR Conference. ‘The processing of your travel documents will start soon as we receive your filled registration questioner forms A,B and C, which must be signed by you. You are hereby required to submit your filled forms not later than March 5° 2015, to enable us forward the "B-2 Visa" support approval to the Consulate General (Visa seetion) at the Embassy of the United States of America in your country of residence for same day visa authorization, unless you are covered, under the U.S. Visa Waiver Permanent Program. Your travel documents’ will be processed here in United States hefore your visit to the U.S Embassy in your Country of Resident. We will get in touch with you soon as we receive all filled registration forms which is xequired to prove that you will attend both venue of the conference. Regards, Dr. Henry Cooper International Society for Human Rights -ISHR California 9011958 CA USA +1,508-425-4326, Participants SignatureDS. . Rk, Conference on Women & Children Abuse Human Trafficking and Neglect ae “please read clearly and if some of these categories don't apply to you then please state by writing N/A Name (Mr. Mrs. Miss.) Nationality Pe ular Penvenent Address: Gagato- Kip ahs Present Address (country of resident) _Duatual Phone Number: + 2() #2} 3) 221 fa Case of Emergency Contact:_+ 3793 3192 1H] aaaress: (/aoeto - kK taba” Gau ub purwme Phone Number! + 905 Y) 4) ) ey of Fax Number: NIA Email address! Can /, wu @ 9 DP. torn ‘What Languages do you speak? (In order of luency):_ 2 bagll) LG Prtuck f L ote King Grane t Passport Number: [> (UU/ 24 type ctPanpet: _ PC “ Marital Status (cirele one): SINGLE MARRIED DIVORCED SEPARATED Name and address of group or Organization: Registration file number fle Su f Ngo) Kab | ory .\*¥s Priel Na Pear ademe 4 location of any international airport close to you! TRATION FOI +8. es | ee. Conference on Women & Children Abuse,Human Trafficking and Neglet 1) Do you have relatives in the U.S.A.? YES / NO (ifyes, please note their address and relationship to you) 2yDescibe experiences with elturally diverse situations: Arawe some Uy ed of 6 buat jrinen _ Cables pejounawany ancy renin? Mo 4) Do you have allergies to certain foods? (List foods) _ Nc { apak foam Muinese Lol 7 Caza) we 5) Do you smoke? YES NO Can you confine your smoking? YES NO Do you have objections to others smoking? YES NO 6) Ifyes, briefly describe: 7) Living abroad exposes you toa ifestyle that you may not be familiar with, Will you be able to adjust to unex sete situations? sitetvine Mick yer, 8) Hobbies and leisure time interests: Jo/iuyyen, Ls af 9) Have you ever been arrested or convicted of a crime? Ifyes, please explain: 7 10) How did you know of this conference? a Ce Me LEGISTRATION FORM» 6