WTDC-17 : Request for a speaking slot during the High-Level Segment

SPEAKER’S INFORMATION

Designation

H.E. Mr	H.E. Ms	Dr	Ms	Professor	Mr

Last Name

First Name

Title / Function

Prime Minister
Minister
Deputy Minister
Secretary General
Under Secretary
Ambassador
Head of Delegation
Observer
Other

Please specify full title:
e.g. "Minister of Communication"

REPRESENTATION

Member State

OR

Sector Member

Click here for Pop-Up Selection Window of ITU-D Sector Members and Associates

SPEAKING SESSION

Original language of the statement:

Arabic	Chinese	English	French	Russian	Spanish

First choice:

Monday 9 October - Afternoon - 14:30 - 15:45
Monday 9 October - Afternoon - 16:00 - 17:00
Tuesday 10 October - Morning - 11:15 - 12:30
Tuesday 10 October - Afternoon - 14:30 - 16:00

Second choice:

Monday 9 October - Afternoon - 14:30 - 15:45
Monday 9 October - Afternoon - 16:00 - 17:00
Tuesday 10 October - Morning - 11:15 - 12:30
Tuesday 10 October - Afternoon - 14:30 - 16:00

DETAILS OF CONTACT PERSON

Full Name

Mobile phone

E-mail:
You can enter several emails if separated by a ;

Official photo of the speaker (to be posted on the website)