application form

Film, governance and society: red tape and celluloid

February 2009 (one week study programme)

Please complete the following application form and select the Send button. If you make a mistake and need to start again, select the Reset button. The completed form will be sent directly to us.

Title

First name(s)

Family name

Date of birth

Nationality

Dietary requirements

Disabilities

Have you participated in a PAI study programme before?

If yes, which programme(s)?

Current Position:

Title of post

Full name and address of your employer

Postcode/Zipcode

Telephone Number (including international dialling code)

Fax Number (including international dialling code)

Email Address

Brief description of your main role and responsibilities

Education and professional training:

Please provide brief details of your educational and professional qualifications and training

School/college/university

Relevant professional qualifications or membership of professional bodies

Particular Interests:

Please indicate which aspects of the programme are of most interest to you?

Sponsoring organisation:

Who will pay for your fees?

Who will pay your other costs such as travel and living costs?

Value Added Tax (VAT):

I certify that I am employed by the Government in furtherance of its sovereign of its activities (Please refer to note on VAT under "Fees and other costs")
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