5thWHO Interregional Seminar for the Quality Control Laboratories

involved in the WHO Prequalification

25-28, October 2016, Shenzhen, PR China

Registration Form – Group A QCLs*

PROPOSED ATTENDANCE DATES (PLEASE TICK APPROPRIATE)

25 and 26 October / 27 and 28, October
Name of the Quality Control Laboratory:
Address:
Contact details for communication related to the above training:
Email:
Telephone number:
Name of the person responsible for nominating the participant:
Title (also indicate if Mr, Mrs, Ms or Miss):
Position:
Email address:
Telephone number:
Signature:
Name of the person being nominated to participate:
Title (also indicate if Mr, Mrs, Ms or Miss):
Position within the Quality Control Laboratory and area of work/responsibility:
Number of years in this position:
Qualifications:
Telephone number:
Email address:
Special dietary requirements:

*Group A QCLs

  • Algeria, LNCPP
  • Armenia, SCDMTE
  • Benin, LNCQM
  • Bolivia, CONCAMYT
  • Brazil, INCQS
  • Brazil, FUNED
  • Burkina Faso, LNSP
  • Cameroon, LANACOME
  • Colombia, INVIMA
  • Cote D’Ivoire, LNSP
  • Dominican Republic, LNSPDD
  • Egypt, NODCAR
  • Ethiopia, DACA
  • Ethiopia, JuLaDQ
  • Ghana, FDB-QCL
  • India, IPC
  • Jamaica, CRDTL
  • Kenya, MEDS
  • Kenya, NQCL
  • Madagascar, AMM
  • Mali, LNS
  • Mauritania, LNCQM
  • Mexico, CCAYAC
  • Morocco, LNCM
  • Niger, LANSPEX
  • Nigeria, NAFDAC
  • Peru, CNCC
  • Senegal, LNCM
  • South Africa, RIIP/CENQAM
  • Sudan, NDQCL
  • Tanzania, TFDA
  • Tanzania, MUHAS
  • Thailand, BDN
  • Tunisia, LNCM
  • Uganda, NDQCL
  • Ukraine, CLQCM
  • Ukraine, LPA
  • Uruguay, CCCM
  • Vietnam, NIDQC
  • Yemen, NQCL
  • Zambia, ZAMRA
  • Zimbabwe, MCAZ

Personal Details of the participant
Please, attach the scanned copy of your passport
The data is required for administrative purposes (invitation letter, travel authorization), and also to cover the relevant payment (part of per diems).
Family Name
First Name
Sex
Date of Birth
Nationality at Birth
Current Nationality
Passport Details / Passport Number:
Issuance date:
Expiry date:
Place of issue:
Address
(full mailing address)
Telephone
(home/mobile/work/fax)
Email
Bank account details
Account Holder Name
Bank Name
Bank Branch Address
(incl. country)
Bank SWIFT code (or BIC)
Account Number
Account IBAN
Preferred Currency

According to the WHO Headquarters procedures, the payment should be made by bank transfer, therefore the bank account details must be completed in this form.

The payment can be made in USD, euro and some other major currencies. The account can be established in any currency.

Please email the complete Registration Form by 20August 2016 to:
Mr Rutendo KUWANA
World Health Organization
20, Avenue Appia
1211 Geneva 27, Switzerland / E-mail: prequallaboratories@who.int
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