Registration Form
LOCAL AND REGIONAL GOVERNMENTS AT COP23
6-17 November 2017, Bonn, Germany

+++ TO SUCCESSFULLY COMPLETE THE FORM, PLEASE MAKE SURE TO HAVE YOUR PASSPORT(S) INFORMATION AND A PORTRAIT PHOTO (SPEAKERS ONLY) FOR ACCESS PURPOSES AT HAND +++

About:

Climate Summit of Local and Regional Leaders (12 November 2017): The Climate Summit of Local and Regional Leaders is the premier gathering of local and regional governments at the 23rd United Nations Climate Change Conference (COP23). Please note: This is an invitation-only event and registration is subject to confirmation due to access limitation.

Cities & Regions Pavilion (6-17 November 2017): The Cities & Region Pavilion is the home base for local and regional governments at COP. With a diverse program throughout the full two weeks, the Pavilion offers a space for events, exchanges, meetings and partnership building.

Registration procedure:

In case of delegations, please note that the first part of the registration form is to be filled out by the Head of Delegation. At the bottom of the form you have the opportunity to add maximum two more delegates from the same organization.

This registration form will close October 23, 2017 - Early registration is highly recommended due to limited space.

For any questions or remarks, please contact cop23.bonn@iclei.org.

Events

Climate Summit of Local and Regional Leaders - Which events are you interested in attending:

12 Nov. 2017: Climate Summit of Local and Regional Leaders

11 Nov. 2017: Evening reception hosted by the City of Bonn

12 Nov. 2017: Evening reception hosted by the State of North Rhine-Westphalia

Cities and Regions Pavilion - Which events are you interested in attending:

Week 1 (6-12 Nov. 2017): An event at the Cities and Regions Pavilion

Week 2 (13-17 Nov. 2017): An event at the Cities and Regions Pavilion

Are you invited as a speaker? *

Yes

No

For which event? *

Climate Summit of Local and Regional Leaders

Cities and Regions Pavilion

Please specify which organization invited you to the Cities and Regions Pavilion: *

Please upload a portrait photo for the Summit program, website, and other relevant materials (jpeg, jpg up to 10MB) *

Are you a member of the media?
Journalists need to go through the accreditation system directly with UNFCCC in order to receive a “Press” badge. *

Yes

No

Please specify *

Journalist

Freelance journalist

Blogger

Areas of expertise / Beats (choose no more than 3) *

Personal Contact Details / Head of Delegation

Please provide the following data if you envisage needing help in accessing the COP23 Bonn Zone.

We collect your official ID information in case further security measures and/or access restrictions are put in place for specific areas or side events.

Please ensure that information is accurate and that your document is still valid to travel. The organizers may store and use passport information for the sole purpose of assisting with access to the COP23 venue.

Organization Details

Local or Subnational Government / Organization / Primary Outlet *

Address *

City *

Postal Code *

State / Region / Province

Country *

Organization Type *

Is your organization affiliated with any local or regional government association? If so, please list below (one entry per line)

+-

Personal Details

Salutation *

Ms

Mr

Agenda

Title

Dr

Prof

Full First Name * 🛈

Full Last Name * 🛈

Title / Job Title (in English) *

Title / Job Title (original language)

Department *

Nationality *

Passport/Official ID Number *

Place of Issue *

Date of Issue * +

Date of Expiry * +

Date of Birth * +

Business Phone (e.g. +49 228 97629900) *

Mobile Phone (reachable at COP23, e.g. +49 176 00000)

Email Address *

Confirm Email Address *

Twitter Handle (optional)

Preferred mode of contact

Email	Phone
Mobile	Social media

Would you like to be contacted through your assistant? *

Yes

No

Assistant Contact Details

First Name *

Last Name *

Job Title *

Department *

Email Address *

Confirm Email Address *

Business Phone (e.g. +49 228 97629900) *

Mobile Phone (e.g. +49 176 00000)

Travel Information

Are you part of a national delegation or UNFCCC accredited organization other than ICLEI that enables you access to UNFCCC Bonn Zone? *

Yes

No

Expecting

Please specify: *

Please tick all options that apply: *

Already accredited with the UNFCCC for COP23

Need a one-day badge to access the Bonn Zone on 12 November 2017

Please provide your travel schedule:

Arrival Date * +

Departure Date * +

I will need an official invitation letter in support of my visa application. *

Yes

No

Disclaimer

*

I am aware that this expression of interest is subject to confirmation and does not guarantee access to the UNFCCC COP23 venue. Information on access requirements and security measures will be communicated at a date closer to the event according to the COP23 Secretariat’s recommendations.

*

I agree to receive updates and communications on local and regional government engagement at UNFCCC COP23.

I wish to subscribe to the daily Digest during the UNFCCC COP23.

I wish to subscribe to the bi-weekly ICLEI iNews newsletter.

I wish to subscribe to the bi-monthly carbonn Climate Registry newsletter.

Special Remarks

Please read the Terms and Conditions carefully. *

I acknowledge that I have read and agree to the Terms and Conditions

Would you like to register other delegates from the same organization?
Please note that due to space limitations we may confirm your participation at a date closer to the event! *

Yes

No

How many other delegates from the same city would you like to register? *

Environment	Climate Change
Development	Energy (clean)
Energy (general)	Finance and Business
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