NOMINATION FORM

Regional Policy Dialogue of Senior Trade Officials on the WTO Negotiating Agenda
in Preparation for Cancun, Bangkok, 10-12 June 2003

Please fill in the required information and return this nomination form to:

Director

Trade and Investment Division

United Nations Economic and Social Commission for Asia and the Pacific

Fax: (66-2) 288-1027, 288-3066

E-mail: chanteeradate.unescap@un.org

UNESCAP reserve the right to reject nominations. Only one representative can attend the meeting
at UNESCAP expense.

I. NOMINATION OF ONE REPRESENTATIVE

TO BE FINANCED BY UNESCAP

1. Name	Mr./Ms. _____________ ____________ ____________ First Middle Last
2. Nationality
3. Date of birth (DD/MM/YY)
4. Functional title
5. Organization
6. Responsibilities
7. Address, telephone, fax, e-mail

II. NOMINATION OF REPRESENTATIVES ON A SELF-FINANCED BASIS

1. Name	Mr./Ms. _____________ ____________ ____________ First Middle Last
2. Functional title
3. Organization
4. Responsibilities
5. Address, telephone, fax, e-mail

For information, please contact Ms. Surang Chanteeradate, Secretary, Trade Policy Section, Trade and Investment
Division, Tel. (662) 288-2087; Fax: (662) 288-1027, (662) 288-3066; E-mail: <chanteeradate.unescap@un.org>