APPLICATION FORM

Identity / Accreditation Card

ກະລຸນາຂຽນແບບຟອມເປັນພາສາອັງກິດ
Passport size
Color
1. Responsible Organization ºö¤¡¾­ê†»®
ñ °ò©§º® Photograph
Office use 4x6
¦½-À²¾½-²½­ñ¡¤¾­

2. Full name as In passport/other travel document §ˆ Áì½ ­¾´¦½¡÷­ ª¾´Îñ¤¦õÀ©ó­ê¾¤

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£ö­ì¾¸ )
Indicate one
- ISF/ASF/NOC Jury member

4. ( b ) Passport No. Îñ¤¦õÀ©ó­ê¾¤ Àì¡ê† ( «É¾´ó ) ISF/ASF/NOC Technical Official

5. Sex À²© 6. Height 츤¦ø¤ 7. Weight ­ÕÎñ¡ 8. Blood Type ϸ©Àìõº©

Female Male Cm Kg 8. ( a ) RH+ RH- 8. ( b ) A B AB O

9. Date of Birth ¸ñ­, À©õº­, ¯óÀ¡ó© 10. Country of Birth ¯½Àê©ê†À¡ó© 11. Nationality ¦ñ­§¾©
Date Month Year

12. ( a ) Sport Discipline ¯½-À²©-¡ì

ò ¾

12. ( b ) Men Team Women Team Both Team

13. E-mail :

14. Responsible Organization signature and seal 15. Applicant signature

À§ñ­ Áì½ ¯½êñ®ª¾¢º¤ºö¤¡¾­ê†¡È¼¸¢Éº¤ 쾨À§ñ­°øɻɺ¤¢ð

President / Secretary General

Date / Date /

Official use only 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