TRAINING APPLICATION FORM

For:Training Course on Spatial Decision Support Systems

(Title of the Training Course)

Date and Venue:25-29November 2013; Karachi, Pakistan

Note:

a.Incomplete or partly-filled application form will NOT be entertained.

  1. ISNET will sponsor participants on the basis of evaluation of the course organising committee and also consider the criteria of first-come-first-served
  2. Sponsorship will depend on the availability of funds

1.Full NameProf □ Dr □Ms □Mr □

______

First Name Middle Name Last Name

2.GenderMale □Female □

3.Title of Present Official Designation/Position

______

4.Organisation

______

5.Official Mailing Address

______

______

Tel (with area codes)______Cell.______

Fax (with area codes)______Email______

6.Personal and Passport Details

Date & Place of Birth______

Nationality______

Passport No.______Place of Issue______

Date of Issue______Date of Expiry______

7.Academic Background

a.Education at undergraduate and postgraduate levels:

Institution / City / Country /
Date
/ Certificate / Degree Awarded / Field of Study
From
/
To

b.Language Proficiency

8.Your professional status and responsibilities in your organisation.

______

______

______

9.Kindly give details of your knowledge and experience of Satellite Remote Sensing and Geographic Information System as well as hands-on skills.

______

______

______

______

10.How is your country likely to benefit from your participation in this training course?

______

11.Financial Support for Return Air-Fare

I will require financial support for my return air ticket. □ Yes □ No

12.Indemnification

I hereby agree to confirm that neither the InterIslamic Network on Space Sciences Technology (ISNET) nor Pakistan Space & Upper Atmosphere Research Commission (SUPARCO), nor the host country (Pakistan) will be responsible for:

i Any costs incurred on visa, vaccination, health and travel insurance, medical treatment, hospitalization etc.

ii.Compensation in the event of death, disability or illness; and

iii. Loss or damage to personal property while attending the training course, during travelling or my period of stay in Pakistan.

13.Undertaking

I agree to refrain from engaging in political, commercial and/or any activities other than those governed by the programme scheduled for the duration of the training course.

Signature: ______

Name:______

Address:______

Date:______

14.Head of the Nominating Agency/Organisation

Signature: ______

Name:______

Date:______

Important: Please complete this form in all respects and faxand e-mail (scanned copy of this page) along with copy of first two pages of your valid passport to the following address no later than 15October 2013:

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