Thirtieth Regional Aviation Safety Group Pan America Executive Steering Committee Meeting — (RASG-PA ESC/30) Washington, D.C., United States, 22 - 23 March 2018 ATTACHMENT C REGISTRATION FORM Chief Delegate Delegate Position in your Delegation: 1. (Please select one option) Adviser Observer 2. Country / Organization 3. Salutation Mr. Mrs. Miss 4. Name 5. Official Position or 6. Official Telephone 7. Mobile (to contact you in case of an emergency) 8. Official E-mail Hotel and address where you will be staying during the 9. event Yes # 10. Please indicate if accompanied by your family 11. Dates of total stay in the venue Country Please indicate if you have any medical condition or 12. allergies Name Emergency contact information in your country of 13. Relationship origin Telephone Please send this form to: E-mail:
Thirtieth Regional Aviation Safety Group — Pan America Executive Steering Committee Meeting (RASG-PA ESC/30) Washington, D.C., United States, 22 - 23 March 2018 ATTACHMENT C REGISTRATION FORM 1. Position in your Delegation: (Please select one option) Chief Delegate Delegate Adviser Observer 2. Country / Organization 3. Salutation Mr. Mrs. Miss 4. Name 5. Official Position or 6. Official Telephone 7. Mobile (to contact you in case of an emergency) 8. Official E-mail 9. Hotel and address where you will be staying during the event 10. Please indicate if accompanied by your family Yes # 11. Dates of total stay in the venue Country 12. Please indicate if you have any medical condition or allergies 13. Emergency contact information in your country of origin Name Relationship Telephone Please send this form to: E-mail: