123
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APPLICATION FORM
Identity / Accreditation Card ກະລຸນາຂຽນແບບຟອມເປັນພາສາອັງກິດ
1. Responsible Organization ºö¤¡¾ê†»® ñ °ò©§º®
Passport size Color Photograph 4x6
Office use ¦½-À²¾½-²½ñ¡¤¾
2. Full name as In passport/other travel document
§ˆ Áì½ ¾´¦½¡÷ ª¾´Îñ¤¦õÀ©ó꾤
3. Name To Be Appear On ID Tag ( 30 Character Only )
쾨§ˆ°øÉê†À¢í¾»È¸´ ª¾´ ID
Function : 4. ( a ) Personal Identity Card No. ( Lao Only ) ®ñ©¯½¥¿ªö¸Àì¡ê† ( ¦½À²¾½£ö쾸 )
Indicate one
-
ISF/ASF/NOC Jury member
4. ( b ) Passport No. Îñ¤¦õÀ©ó꾤 Àì¡ê† ( «É¾´ó )
5. Sex À²© Female
6. Height 츤¦ø¤ 7. Weight ÕÎñ¡ Male
Cm
Kg
9. Date of Birth ¸ñ, À©õº, ¯óÀ¡ó© Date
Month
8. Blood Type ϸ©Àìõº©
8. ( a ) RH+
RH-
8. ( b ) A
10. Country of Birth ¯½Àê©ê†À¡ó©
B
AB
O
11. Nationality ¦ñ§¾©
Year
12. ( a ) Sport Discipline
12. ( b )
ISF/ASF/NOC Technical Official
Men Team
¯½-À²©-¡ì ò ¾
Women Team
Both Team
13. E-mail : 14. Responsible Organization signature and seal À§ñ Áì½ ¯½êñ®ª¾¢º¤ºö¤¡¾ê†¡È¼¸¢Éº¤
15. Applicant signature 쾨À§ñ°øɻɺ¤¢ð
President / Secretary General
Date
/
Official use only
Date
/
16. Transport ¢ö-¦‰¤
Accreditation approved by : º½÷´ñ©-ùÉ-©¨
Date
/
The Application form must be returned to the Accreditation Office, LAOSOC not later than October 26, 2009 www.laosoc.com, www.laoseagames2009.com
Identity / Accreditation Card ກະລຸນາຂຽນແບບຟອມເປັນພາສາອັງກິດ
1. Responsible Organization ºö¤¡¾ê†»® ñ °ò©§º®
Passport size Color Photograph 4x6
Office use ¦½-À²¾½-²½ñ¡¤¾
2. Full name as In passport/other travel document
§ˆ Áì½ ¾´¦½¡÷ ª¾´Îñ¤¦õÀ©ó꾤
3. Name To Be Appear On ID Tag ( 30 Character Only )
쾨§ˆ°øÉê†À¢í¾»È¸´ ª¾´ ID
Function : 4. ( a ) Personal Identity Card No. ( Lao Only ) ®ñ©¯½¥¿ªö¸Àì¡ê† ( ¦½À²¾½£ö쾸 )
Indicate one
-
ISF/ASF/NOC Jury member
4. ( b ) Passport No. Îñ¤¦õÀ©ó꾤 Àì¡ê† ( «É¾´ó )
5. Sex À²© Female
6. Height 츤¦ø¤ 7. Weight ÕÎñ¡ Male
Cm
Kg
9. Date of Birth ¸ñ, À©õº, ¯óÀ¡ó© Date
Month
8. Blood Type ϸ©Àìõº©
8. ( a ) RH+
RH-
8. ( b ) A
10. Country of Birth ¯½Àê©ê†À¡ó©
B
AB
O
11. Nationality ¦ñ§¾©
Year
12. ( a ) Sport Discipline
12. ( b )
ISF/ASF/NOC Technical Official
Men Team
¯½-À²©-¡ì ò ¾
Women Team
Both Team
13. E-mail : 14. Responsible Organization signature and seal À§ñ Áì½ ¯½êñ®ª¾¢º¤ºö¤¡¾ê†¡È¼¸¢Éº¤
15. Applicant signature 쾨À§ñ°øɻɺ¤¢ð
President / Secretary General
Date
/
Official use only
Date
/
16. Transport ¢ö-¦‰¤
Accreditation approved by : º½÷´ñ©-ùÉ-©¨
Date
/
The Application form must be returned to the Accreditation Office, LAOSOC not later than October 26, 2009 www.laosoc.com, www.laoseagames2009.com
