Please complete the booking form and return with conference fees by July 30th, 2004 to:

Ms. Sylvie O'Callaghan
Conference Operations Manager
IHRAAM/ICHR
Avenue des Arts 57 B-1000 Brussels
Tel (0032) (0) 2 505 58 80
Fax (0032) (0) 2-505 58 89

 CONFERENCE ONLY:  400,- EURO
     Includes: Three days Conference                                                                     

- Welcome Cocktail: 6^th (instead of lunch)
- Coffee breaks: 6^th (1), 7^th (2), 8^th (2); croissant in the morning, cake in the afternoon
- Lunch: 7^th and 8^th ; 3-course Business lunch with coffee or wine/beer/mineral water
- Dinner: 6^th, 7^th and 8^th

CONFERENCE PLUS ACCOMODATION SINGLE ROOM:  850,- EURO 
Three nights, 6^th, 7^th & 8^th
- Rooms are equipped with bathroom, hair dryer, minibar, telephone, radio, colour television with cable network, outlets for PCs and Telefax.
- Breakfast included                       
- Total Local Tax included

CONFERENCE PLUS ACCOMMODATION/DOUBLE ROOM, PRICE PER PERSON:  700,- EURO
- Three nights, 6^th, 7^th & 8^th
- Rooms are equipped with bathroom, hair dryer, minibar, telephone, radio, colour television with cable network, outlets for PCs and Telefax.
- Breakfast included           
- Total Local Tax included

ALL CHECKS OR MONEY ORDERS SHOULD BE MADE PAYABLE  TO:  International Council for Human Rights (ICHR)

A P P L I C A T I O N   F O R M
Second International Conference
on the Right to Self-Determination, the United Nations and International Civil Society
Ramada Park Hotel, Geneva, August 6-8th.

Title: (Mr./Mrs./Ms/Other) ________________________________________________
Surname (for name badge): ______________________
 First name:_____________
Job title: _____________________________________________________________
Address : ____________________________________________________________
_____________________________________________________________________
Tel: ______________________________ Fax:_______________________________
E-mail:___________________________  Website: ___________________________

ORGANIZATION: ______________________________________________________
Address: ____________________________________________________________
_____________________________________________________________________
Tel: ______________________________ Fax:_______________________________
E-mail:___________________________  Website: ___________________________

Languages spoken: ____________________________________________________

(Conference shall be conducted in ENGLISH)

Vegetarian food required:    Yes____  No _____

Accommodation required (shared)  Yes_____No_____

I have other special needs: ______________________________________________
_____________________________________________________________________

I am interested in presenting under Conference Theme _______

The topic of my intervention would be:
______________________________________________________________________
______________________________________________________________________

I am interested in participating in Workshop(s) No(s).: _______________________

I consent to have my name and contact information published in the conference list ___________________

My check/money order in the amount of US$__________ Fees plus board
                                                                            US$__________ Fees only
is enclosed.

SIGNATURE: ___________________________Date: _______________