Summer International Presidents’ Meeting

3rd-8th of August 2010, Lisbon

Summer IPM Lisbon Application No ______

(Office Use)
Application Form (send to ipm.elsaucplisboa@gmail.com)
Registration deadline: 3rd July 2010

Delegation (National Group) ________________________

Head of Delegation ________________________________

Participant Details

Name _____________________ Surname ______________________

Date of Birth _ _/_ _/ _ _ Sex: Male/Female

Address
________________________________________________________________________

City _________________________ Country _________________ Post Code

_____________

Telephone Number (Fixed Line) _________________ (Mobile Number)

_________________

Email Address ________________________________________________

ID Card No ________________________Passport Number

__________________________

Passport Date of Issue ___________________ Passport Expiry

Date_____________________

Do you need a visa to enter Malta? __________

Other Information:
Are you a vegetarian? Y/N

Do you have any other food requirements?

____________________________________________

Do you have any allergies/medical conditions?

___________________________________________________________

Please include any other special requirements you might have here.
____________________________________________________________

ELSA Information

ELSA National Group ________________________________

ELSA Local Group ___________________________________

Position in Local/National Group ________________________

Who would you like to share a room with? (Maximum 2 people other than
yourself)
Please include their name and their ELSA Group.

1. __________________________________

2. __________________________________

Travelling Information

Arrival Flight Number ______________________

Date of Arrival ____________________________

Time of Arrival ____________________________

Departure Flight Number _____________________

Date of Departure ___________________________

Time of Departure ___________________________

Number of Extra Nights _______________________ (please, put the extra

nights’ dates)
Additional Costs (Please tick if yes)
Airport Transfers (15 Euro) ________
Social Programme (15 Euro) _______
Gala Ball (35 Euro) _______________
Sightseeing (15 Euro) _____________
Extra Nights (35 Euro) ____________

Payment details:
Payment must be made by bank transfer. After we receive your registration form
and accept your application, we'll give you details of our bank account and the
fee that you have to pay. After that, you'll have a period of five days to send in
proof of bank transfer. The participation will be confirmed only after we receive
the proof of bank transfer.

Disclaimer:
I, _____________________________________ (name), confirm that all the details
stated above are correct and true. I am aware that after sending my
application and after the deadline on July 3rd I will not be able to withdraw
my application, therefore I will be obliged to pay the entire fee for the IPM.
Signature: ____________________________

DEADLINE FOR APPLICATIONS :

July 3rd 2010