Call for Nominations for a Basic Course on

Assistance and Protection against Chemical Weapons

Please make sure to complete all necessary fields before applying to a course

Region of the nominee: *

Country of the Nominee *

Gender *

Male

Female

First name(s) * 🛈

Middle name(s) * 🛈

Family name of nominee * 🛈

Employer: *

Position: *

Roles and responsibilities: *

Area of expertise: *

Address of employer: *

Date of Birth * 🛈 +

Passport number *

Date of issue * 🛈 +

Date of expiry * 🛈 +

Place of issue of your passport

Email address *

Mobile phone number *

Work phone number *

Home phone number

Has the nominee previously attended a meeting of this kind? *

Yes

No

If yes, provide details:

Is sponsorship a condition of participation? *

Yes

No

Airport of departure *

Dietary preference: *

Gloves Size *

S

M

L

Boots Size: * 🛈

Height *

Weight: *

Please attach letter of endorsement:

Please attach your CV