MSDI Open Forum (30 January 2013) and MSDIWG4 (31 January & 1 February 2013)

Registration Form

Please return this form to Mr. Jens Peter Hartmann (jepha@kms.dk) and Ms. Suzanne Slarsky Dael (susla@kms.dk) no later than 17 January 2012.

MSDIWG Members, please indicate country _____________________________________
Observers, please indicate country and/or organization ____________________________

Participant 1

Registration for:   Open Forum only (  )   MSDIWG4 only (   )   Both meetings (   )

Rank or Title______________________________________________________
Surname_________________________________________________________
First Name________________________________________________________
Email Address_____________________________________________________
Telephone Number_________________________________________________

Participant 2

Registration for:   Open Forum only (  )   MSDIWG4 only (   )   Both meetings (   )

Rank or Title______________________________________________________
Surname_________________________________________________________
First Name________________________________________________________
Email Address_____________________________________________________
Telephone Number_________________________________________________

Please list additional participants’ information on a separate sheet.