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Registration Form

On-the-Spot Poetry Writing Contest

Entry Number_______________
FULL PRINTED
NAME__________________________________________________
Address
_______________________________________________________
_______________________________________________________
Age ____________ Birth Date _______________________
(Month, Date, Year)

Contact Number
Tel. No. (if any) ______________ Mobile No. (if any) ____________
Email Address: ____________________

If a student:
Year Level___________________
School
_______________________________________________________
School Address
_______________________________________________________
_______________________________________________________
If a member of the organization of victims’ families:
Organization
_______________________________________________________
Address

_______________________________________________________
______________________________________________________

__________________________________________
Signature over printed name of contestant

Please fax, email or send not later


than December 4, 2009 to:

Asian Federation Against Involuntary Disappearances


Rms. 310-311 Philippine Social Science Center Building
Commonwealth Avenue, Diliman, 1103 Quezon City Philippines
Telefax 00-632-4546759 Telephone Number 00-632-9274594 Mobile 00-63-9177924058
Email afad@surfshop.net.ph website www.afad-online.org

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