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  • The 3rd ASEAN + 3 Village Leaders Exchange Program: 1. Basic Information

    Uploaded by

    Abdul Lathif Hamdy
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    This registration form provides information about Ruslizar Rizal, a village head from Indonesia, who is participating in the 3rd ASEAN + 3 Village Leaders Exchange from November 15-22, 2015 in Nanning, China. The form includes his personal details such as name, date of birth, nationality, passport information, arrival and departure details. It also lists his organization information including his role as village head of Lubuk Bayas Village in North Sumatera Province, Indonesia, along with his contact details. Finally, it requests information about his meal preferences and dietary restrictions.

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    kunjungan kerja

    Original Title

    Guangxi China

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    This registration form provides information about Ruslizar Rizal, a village head from Indonesia, who is participating in the 3rd ASEAN + 3 Village Leaders Exchange from November 15-22, 2015 in Nanning, China. The form includes his personal details such as name, date of birth, nationality, passport information, arrival and departure details. It also lists his organization information including his role as village head of Lubuk Bayas Village in North Sumatera Province, Indonesia, along with his contact details. Finally, it requests information about his meal preferences and dietary restrictions.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    12 views4 pages

    The 3rd ASEAN + 3 Village Leaders Exchange Program: 1. Basic Information

    Uploaded by

    Abdul Lathif Hamdy
    This registration form provides information about Ruslizar Rizal, a village head from Indonesia, who is participating in the 3rd ASEAN + 3 Village Leaders Exchange from November 15-22, 2015 in Nanning, China. The form includes his personal details such as name, date of birth, nationality, passport information, arrival and departure details. It also lists his organization information including his role as village head of Lubuk Bayas Village in North Sumatera Province, Indonesia, along with his contact details. Finally, it requests information about his meal preferences and dietary restrictions.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    The 3rd ASEAN + 3 Village Leaders Exchang

    15-22 November 2015


    REGISTRATION FORM
    1. Basic Information
    Dr.

    Mr.

    Mrs.

    Title
    Full Name (as in
    passport)

    First Name :

    RUSLIZAR

    Last Name :

    Name (as appears in the


    RIZAL
    name tag)
    Gender

    Male

    Date of
    birth (dd/mm/yy)

    SEI BULUH, 18 JANUARI 1970

    Nationality

    INDONESIA

    2. Travel Details
    Passport Type
    Passpaort No

    Ordinary

    Official

    B 2501859

    Arrival (Nanning)
    Arrival
    Flight No

    Arrival Date (dd/mm)


    Depature (Nanning)
    Depature Date
    (dd/mm)

    Depature
    Flight No

    3. Organization Information
    Ministry /
    Organization

    Village Government Lubuk Bayas

    Department

    Goverment Bedagai Serdang

    Position

    Village Head

    Mailing Addres

    Lubuk Bayas Village, Districts Perbaungan Serdang Bedagai, North Su

    Telephone Number

    085262337060

    Facsimile Nimber

    0621 - 41257

    E-mail Address

    bpmpdsergai@yahoo.com

    Position in Delegation
    (please tick one)

    Head of Delegation

    Delegate

    Panelist

    4. Meal Information
    Vegetarian
    Dietary Preferance
    Others

    Other requests
    Position

    Muslim

    eaders Exchange Program

    ber 2015
    N FORM

    Ms.

    Other

    Attach recent
    photo her
    Female

    Diplomate

    Arrival
    Time

    Depature
    Time

    rdang Bedagai, North Sumatera Province, Indonesia

    Other

    Observ
    er

    Researcher

    Hindu

    None

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