Kindly submit this form on or before Tuesday, 15 May 2018.

PARTICIPATION IN THE ACTIVITY

____ YES. I/we will attend the Municipal Social Protection Technical Working Group Conference
and Presentation of Preliminary CSO-led Social Protection Monitoring Results on 22 May 2018.
(Kindly complete the next item on the slip)

___ No. I/we would like to send my/our regrets.

PARTICIPANTS’ INFORMATION

PARTICIPANT 1:

Name

Designation

Office

Contact details (email,

contact number
Gender ___ Female ___ Male
___ LGBTQI ___ Prefer not to disclose

Dietary restrictions
(allergies, diet type, etc.)

Date/time of arrival to
Palo, Leyte

Date/time of departure
from Palo, Leyte

Would you be needing ___ Yes. Check-in date/time: __________________________;

accommodation? Check-out date/time: _________________________
___ No. I will not be needing accommodation

PARTICIPANT 2:

Name

Designation

Office
 Contact details (email,
contact number
Gender ___ Female ___ Male
___ LGBTQI ___ Prefer not to disclose

Dietary restrictions
(allergies, diet type, etc.)

Date/time of arrival to
Palo, Leyte

Date/time of departure
from Palo, Leyte

Would you be needing ___ Yes. Check-in date/time: __________________________;

accommodation? Check-out date/time: _________________________
___ No. I will not be needing accommodation

PARTICIPANT 3:

Name

Designation

Office

Contact details (email,

contact number
Gender ___ Female ___ Male
___ LGBTQI ___ Prefer not to disclose

Dietary restrictions
(allergies, diet type, etc.)

Date/time of arrival to
Palo, Leyte

Date/time of departure
from Palo, Leyte

Would you be needing ___ Yes. Check-in date/time: __________________________;

accommodation? Check-out date/time: _________________________
___ No. I will not be needing accommodation

Thank you very much.

__________________________

Signature over printed name