Document B511yBVo9joZz6KobjXvG11vX

Industry and Economy Division REGISTRATION FORM Global Consultation on Chemicals and Waste Issues of Concern 11 and 12 JULY 2023, GENEVA, SWITZERLAND Please type or write clearly and return the completed form no later than 08 June 2023 to the Chemicals and Health Branch, UNEP by e-mail to (@un.org) with a copy to (@un.org). Institution/Organization: Government Business/Industry NGO IGO Other (please specify) ____________ Mr. Ms. First Name: Last Name: Functional Title: Section / Department: Mailing Address: Postcode: Country: E-mail: Participant Information Date of Birth: Nationality: City: Mobile: I wish to participate in the Global Consultation on Chemicals and Waste Issues of Concern I wish to receive funding support for the Global Consultation on Chemicals and Waste Issues of Concern (Please send along a copy of the identification page of your passport). For participants requesting for financial assistance My city of departure is (Airport): Date: Signature: Important notes: Participants requesting funding must also submit a copy of the first page of their national passport. All participants are responsible for obtaining their visa for entering Switzerland, as well as any necessary transit visa(s), as appropriate. Visa support letters can be provided upon request.