TRAINING

 

International Code Documentation Centre

Annual Training Course

Application Form

 

Print this form, complete it and mail it to:

Director, ICDC, PO Box 19, 10700 Penang, Malaysia

or fax to: +60-4-8907291

or email your details to ibfanpg@tm.net.my

For further detail phone: +60-4-8905799

Applications will be accepted until 1 August 2004. Places are limited so it is best to apply early.

 

ICDC Annual Training Course on implementing the International Code of Marketing of Breastmilk Substitutes

20-28 September 2004
Penang, Malaysia

APPLICATION FORM

 

Name: _____________________________________________________

First Name: _________________________________________________

Male Female (please circle)

Nationality: _________________________________________________

Ministry/Organisation: ________________________________________

____________________________________________________________

Title/Position: _______________________________________________

____________________________________________________________

Mailing address: _____________________________________________

____________________________________________________________

____________________________________________________________

Country: _________________________________________________

Telephone: _______________________________________________

Fax: _____________________________________________________

E-mail: ___________________________________________________

The costs for my participation:

  • Travel to Penang, Malaysia

  • Accomodation and all meals in a 4-star hotel (package deal approximately US$60 to $70 per day)

  • Registration fee (US$500)

will be paid by: ___________________________________________