Fake Conference Registration form from Mr. Larry Brinkin Registration Desk Global Right World Organization ghrwo@usa.com +1201-984-4588 +1206-309-4286 ghrwo.webs.com

GHRWO-REGISTRATION FORM-A-B1-B2-.pdf

We will get in touch with you soon as we receive all filled registration forms and your hotel reservation
receipt which is required to prove that you will attend both venue of the conference.
Regards,
Mr. Larry Brinkin
Conference Registrar Participants Signature
Global Human Rights World Organization (GHRWO)
Atlantic City, NJ, 08401
United States of America.
Registrar Signature Phone: +1 (201-984-4588 / Fax: + 1-206-203-1405
Secretariat Use Only
DATE REGISTERED.: 27-11-2014
REGISTRATION NO.: CR98515483/USGB-12
The file was opened with the following details
FIRST NAME & M.I: <insert name>
LAST NAME: <insert name>
PASSPORT N NO: <insert number>
DATE OF BIRTH: 01/09/1980
PLACE OF BIRTH: DUBAI
COUNTRY OF RES: USA
You have been registered to join the list of participants
to participate in the Global Human Rights World
Organization (GHRWO) Against Economic Crisis, Child
Abuse & HIV/AIDS Treatment, Sex Work and forced
Labor,
DELEGATE REGISTRATION INFORMATION
Title: Dr. Prof. Ms. Mrs. Mr.
The processing of your travel documents will start as
soon As we receive the International Passport copy and
your registration forms which must be filled and
submitted along with your hotel reservation Receipt
from Aissata Camara Hotel in Dakar-Senegal.
You are hereby required to submit the filled forms and
reservation receipt not later than Dec 13th 2014 to
enable us forward the Visa" support approval to the
Consulate General (Visa section) at the Embassy of the
United States of America Consulate in your country of
residence for same day visa authorization, unless you
are covered, under the Visa Waiver Program (GHRWO)
*Please read clearly and if some of these categories don't apply to you then please state by writing N/A
Name (Mr. Mrs. Miss.)
Nationality Permanent Address:
Present Address (country of resident) Phone Number:
In Case of Emergency Contact: Address:
Phone Number: Fax Number:
Email address:
What Languages do you speak? (In order of fluency):
Passport Number: Type of Passport:
Marital Status (circle one): SINGLE MARRIED DIVORCED SEPARATED
Name and address of group or Organization:
Registration file number :
location of any international airport close to you:
1) Do you have relatives in the U.S.A.? YES / NO (if yes, please note their address and relationship to you)
2)Describe experiences with culturally diverse situations:
3) Religion: Do you have any dietary restrictions?
4) Do you have allergies to certain foods? (List foods)
5) Do you smoke? YES NO Can you confine your smoking? YES NO Do you have objections to others smoking?
YES NO
6) If yes, briefly describe:
7) Living abroad exposes you to a lifestyle that you may not be familiar with. Will you be able to adjust to unexpected
situations?
8) Hobbies and leisure time interests:
9) Have you ever been arrested or convicted of a crime? If yes, please explain:
10) How did you know of this conference?