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"extension friendly " Dhaka activity registration form

Event/activity  Registration Form ( in dhaka with possibility of extension case1: enlargement )

[ The asteric (*) fields are compulsory and the form will not be accepted if any of these is not provided.]

Name of Organization

Address

Country

Email

Email 2

Email  3  ( see point 7 )

Website

Phone/ Mobile

Contact Person

Position

Co-organiser(s)

Are you publicily agreeing with social forum charter of principles  (link )   Yes - no 

Title of event

Short brief about the topics (300 chars left) *

Give a url adress where to find more information about your activity and /or  interaction with you around the preparation of this activity ( note that you can create freely an on line space around your activity in a wsf provided website  "www.openfsm.net" ) : 

Thematic Area

Type of event and registration fee

Date of event (proposed)

Event time slot

Additional requirements (specify)

Name of Guest Speaker / Performer(s)

 Do you intend to enlarge your event/activity on internet in order to allow remote participation in it  ( one person with laptop camera  for live internet video stream out of dhaka and  on one liaising person with laptop for receiving  text chat feedback towards dhaka  ) Yes No  maybe ( in case of yes or maybe  extension team will come back to you ) 

Payment Option Online Pay Order

Do you want to receive SASF E – bulletin? Yes No