Conference on the Political Participation of PwD

Tirana, 25th November– 27th November 2019

REGISTRATION FORM
Please complete this form and send it by email to erlinatafa63@gmail.com no later than Thursday
7th November 2019

PERSONAL DETAILS (All fields must be completed)

Full Name (as it appears in the passport)

Passport number
Expiration Date

Address - Country
City from where you travel to the event

Email
Mobile phone (please include country code)

Dietary requirements
ORGANISATIONAL DETAILS

Party / organisation
Country

Position in the party / organisation

Requires formal letter of invitation Yes (Mark with a cross) No

Requires letter of invitation for visa Yes (Mark with a cross) No

application
Party / organization email (for
coordination purposes).

IMPORTANT: All participants must have a passport valid for 6 months or more,
in order to comply with UK entry requirements.

Picture (insert picture here)

Brief bio

I understand that the Conservative Party WFD Programme may take photos and / or videos
of programme participants during programme activities and events for use in educational or
promotional materials in print, multimedia, or web form. Photos / videos will only be used
for purposes related to the Conservative Party WFD Programme and their related partners.

Please check the correct box below as to whether you do wish or do not wish to grant the
Conservative Party WFD Programme to use your photos/videos taken during a program.
Additionally, please complete the information below and sign this form in verification of your
permission regarding Conservative Party WFD Programme’s use your photos/videos.

☐ I DO grant permission for the use of my photo/video.

☐ I DO NOT grant permission for the use of my photo/video.
By returning the completed form, you agree to your data being stored for the
purposes of the Conservative WFD Programme.

Signature _____________________________________ Date _______________________