NATO/EAPC UNCLASSIFIED Releasable to Mediterranean Dialogue, Istanbul Cooperation Initiative, Afghanistan, Australia, Iraq, Japan, Mongolia, The Republic of Korea, New Zealand and Pakistan

ANNEX 3AC/98(EAPC)N(20016)0006 MULTI REF

EXERCISE “CRNA GORA – 2016”REGISTRATION FORM FOR THE FINAL PLANNING CONFERENCE

27-30 June, 2016, Podgorica

Family name : First name :Mr. / Mrs. / Ms. Date of Birth :Nationality : Place of Birth :Organization : Passport No. :Function : Valid until :

Needs a Visa Yes No Passport type :

Invitation required Yes No

Country of residence

:

Mailing address StreetCity and Postal codeCountry

Telephone : Fax :E-mail :

will participate in the Final Planning Conference of the exercise “CRNA GORA - 2016”

Arrival and departureMode of travel (car, train, plane)Date, time airport or station of arrivalDate, time airport or station of departure

Transportation is requested? Yes No

Any special dietary requirements:

To register, fax or e-mail this registration form to both:EADRCCNATO Headquarters1110 BrusselsBelgiumTel.: +32-2-707.2676Fax.: +32-2-707.2677e-mail: eadrcc@hq.nato.intPOC: Mr. Stefano Santamato

The Directorate for Emergency Management of Ministry of the Interior, Podgorica, MONTENEGRO

Tel.: +382-20-481-829Mob: +382-67-9-112-015Fax.: +382-20-481-833e-mail: milan.s.radovic @mup.gov.me mup.emergency.op@t-com.me POC : Mr. Milan Radović

Deadline for registration: 6 JUNE 2016

NATO/EAPC UNCLASSIFIED 6-1