THE FIFTH ASIA – EUROPE MEETING (ASEM 5)

8 – 9 October, 2004 Hanoi, Vietnam

MEDIA ACCREDITATION APPLICATION FORM

Name (Print):...... Last/Middle/First Gender: Male:  O Female:   O                 

Date of birth  ......................................  DD/MM/YYYY                 Nationality:  ..................................................         

Passport number: ................................               

Issued by:   ....................................................

Expiry date: .........................

Media organization:  ....................................................

Business address:   ...........

Telephone: ......................Fax:  .........................

Email address:.................................................

Position:          

Reporter:                            

Photographer:                                            

Cameraman:                               

Technician:                                          

Member of Delegation’s Accompanying Press:        Yes O        No O                          Others (please specify): ..............

Visa pick-up place:........ .............................................

Proposed date of arrival:.......................... 

Proposed date of departure:   ....................................

Do you require reservation for:     Accommodation:          Yes O            No O                                                                                

Transportation:             Yes O            No O                                                                 Others (please specify) ............................................

Date:   ................................................

Signature: .................................................

Please attach three passport colour photos and return this completed form, by express mails, no later than 27 September, 2004 to the Press and Information Department, Ministry of Foreign Affairs No. 7 Chu Van An Str., Hanoi, Vietnam

Telephone: 84 4 8455401    Fax:  84 4 8234137        

 Email: bc.mfa@mofa.gov.vn

THE FIFTH ASIA – EUROPE MEETING (ASEM 5)

 8 - 9 October, 2004 Hanoi, Vietnam

LIST OF MEDIA EQUIPMENT

Name:                                                                    

Media organization:

Passport No.:                                                       

Date: No.

Item Quantity Serial No.            

Signature:

Please return this list with the accreditation application form, no later than 27 September, 2004 to the Press and Information Department, Ministry of Foreign Affairs No.7 Chu Van An Str., Hanoi, Vietnam Telephone: 84 4 8455401 

Fax:  84 4 8234137         Email: bc.mfa@mofa.gov.vn