Registration

Family Name:
Given Name:
Middle Name:
Gender: Male       Female
Nationality:
Name of your Institution/Organization/School:
Current Status:  Graduate Student
 Undergraduate Student(Senior only)
Majoring in:
Researcher
 Professor      Assistant Professor      Lecturer
Subjects you are teaching:
 Public Officer
Section/Department/Division,(type of work engaged in):
 Staff for Victim Related Organization
Specialty of your work:(e.g.Assistance to Crime Vicvtims,Child Abuse Hotline,etc.)
 Others
Present Address
Country
Zip Code
Phone
Fax
Email
How many days will you attend? Two weeks
One week
(From(date) to(date) )
Less than one week
( days → when? (date) )
What kind of lodging would you like to stay in during this course? International Hall
(Only for full-time foreign participants)
Home Stay
(Only for full-time foreign students)
Others
(Youth Hostel, City Hotels, etc. to be reserved by participants themselves)
How did you come to know about this course? Handbill or poster circulated in your institute/organization/school
Recommended by your colleague/teacher/friend. If it’s ok, please give his/her name.
( )
On our TIVI’s Website
Others
( )
Message
     

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