| *Email:
|
|
| *Title
of Courtesy: |
|
| *First
Name: |
|
| *Last
Name: |
|
| *Nationality: |
(indicate country) |
| *Age: |
Female
Male |
| Job Category: |
|
| Name of Company: |
|
| *Address: |
|
| *City:
|
|
| *State: |
|
| *Postal
Code: |
(no country initials) |
| *Country: |
|
| *Phone: |
(incl. country code, ex. +41223335555) |
| *Fax: |
(incl. country code, ex. +41223335555) |
|
| Authorization for data use: I
hereby authorize Awaken Women International to use this
information exclusively for the purpose of the International
Women's Conferences in accordance with the EU Privacy
Directive. |
|
|
