This document is a registration form for a workshop. It requests the attendee's name, gender, organization, address, contact information, supervisor's contact, and type of work. The form must be completed and sent by email before June 15, 2013 at 5PM to register for the workshop on an unspecified date.

1. Registration Form
No:TASK/WS/RF/013/01
Title of the workshop:__________________________ ____ Date: ___/___/___
Name of birth: ______________________( English):_____________________Gender: M F
Organization: _______________________Position:____________________________________
Address: H#_________Str:______________Village __________________ Commune_________
District Province/City Country
Office Tel: _________________________ Email: ___________________________ __________
Personal Contact: (H/P)__________ __ _ Email: __ ___
Supervisor’s contact: (H/P)_________________ _______Email: ___ ________ _____
Please tick  type of your work profile:
INGO Local NGO UNHCR National Refugees office
Refugees and Asylum Seekers MoEYS Individual
Others/Please specific:
Signature: ____________ ____________Date of submitted: ______/________/____________
Supervisor’s approval:_____________ _____________________________________________
Any recommends, please:__ ____________________________________________________
_____________________________________________________________________________
Kindly complete this form and send directly to information@task.org.kh /
phanna4tdur@yahoo.com / sothearath_mam@yahoo.com You are requested to
complete this form and send back to e-mail above before June 15th
, 2013 at 5:00PM
............................................................................................................................................
For office use only:
No: TASK/WS/RF/013/01
To affirm that Mr./Ms. ________________________ from___________________________
Was accepted to attend the workshop on_____________ _______________________
which will conduct from _____________________________at__________________________
Seen and approved by: _______________________________ Date: ___________________________