REGISTRATION FORM

To be returned to the ITU Regional Office e-mail: FTRA-2009@itu.int Fax: +251 11 5517299

Mr Mrs Ms Miss

Administration of ITU Member State

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Family name

ITU Sector Member

ITU Associate

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First name

Non-Member

Name and full address of administration or organization:

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Tel.: ____________________________________

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Fax: ____________________________________

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E-mail: __________________________________

Date: ___________________________

Signature: ______________________________________