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)
Message
     

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