Name (surname/forenames) * :	Mr Ms Miss Dr Please enter your name.
Institution * :	Please provide the name of your institution.
Email address:	Please provide your email address. Please provide valid email address.
Nationality * :	Please provide your nationality.
Postal Address * : Number/street:	Please provide postal address: house number and street.
City * :	Please provide the name of your city.
State/region:
Zip Code/Postal code:
Country * :	Please provide your country name.
Telephone * :	Please provide your telephone number.
Fax:
Skype ID:

Planned date of arrival in Kathmandu	Please provide the date in YYYY-MM-DD format.
Flight number into Kathmandu
Planned date of departure from Kathmandu	Please provide the date in YYYY-MM-DD format.
Flight number

*Note that if your travel plans are not yet confirmed please remember to inform us once they are fixed.

Do you wish us to arrange accommodation in Kathmandu on your arrival in Nepal?	Yes    No
What is your preferred price range? (per night rate)	NOT APPLICABLE    < USD 30    USD 30-80    > USD 80
Do you wish us to book your accommodation in Pokhara at the Pokhara Grande Hotel (the workshop venue where special rates have been negotiated for participants)?	Yes (please arrange) No(please arrange elsewhere) No (I will make my own arrangements)
If you wish to stay elsewhere what is your preferred price range? (per night rate)	NOT APPLICABLE    < USD 30    USD 30-80    > USD 80
Do you wish to stay on in Pokhara after the workshop?	Yes    No
If Yes, please indicate the number of days :

Do you wish us to arrange your travel to and from Pokhara from Kathmandu?	Yes    No
Preferred Mode of travel?	NOT APPLICABLE Luxury bus (no cost to workshop participants) Air (return cost approximately US$150)

Dietary preferences? (Max 200 Chars Allowed)	Only 200 characters allowed
Any other specific requirements? (Describe)	Only 200 characters allowed
Do you require English-Nepali translation facilities?	Yes    No

Do you wish to extend your stay in Pokhara to take optional field visits (2 days) after the workshop	Yes    No
What is your specific interest on these visits (this will help us to plan and organise them)?	Only 200 characters allowed

*Note that there will be an additional cost payable for these optional field visits.

International Participants US $ 300	Nepali participants is NRs 1,500
I will pay via	WIRE TRANSFER
	1. Wire Transfer Account Name : Swiss Foundation for Development and International Cooperation Nepal (Intercooperation Nepal) Account No : US $ ACCOUNT 01-1754297-51 Bank Name : Standard Charter Bank Bank Address : New Baneshwor, Kathmandu, Nepal Swift Code : SCBLNPKA Memo : You should include your name and email address used during registration in memo. After making wire transfer please email us [at cpfd@wlink.com.np or p-branney@lfp.org.np] providing the following informations. This will enable to identify your payment and process your registration as soon as possible. 1) Account Title (Exact sender as in bank wire) 2) Bank Account No (Account No from where wire is sent) 3) Your Bank Name (Name of wire sending bank) 4) City 5) Province/ State 6) Country 7) Amount & Currency BEFORE YOU PLACE AN ORDER, READ ABOUT WIRE RELATED FEES Payment sender (Participant) is responsible to pay ALL bank charges. You should select option "OUR" (sending & receiving fees paid by sending party) and if not sure do ask your bank how much it will cost to send a certain amount and it should be paid by you. It should also be noted that some banks use intermediary banks to send a wire, if these banks charge a fee amount will result in lower when reaching our account. It is best to ask your bank for all expected fees before sending a wire, to ensure accurate registration payment at our account, it will avoid any delay in registration processing.

*Note that all travel (except buses to and from Kathmandu to Pokhara), all accommodation, and any additional optional field visits must be paid for directly by participants and is not included in the workshop fees above.