WCN Autumn 2009
John C HoggTravel Award to wire Düsseldorf 12-16 April 2010 Application Form To: International Wire & Machinery Association Fax: 44 (0) 1926 314755 46 HollyWalk, Leamington Spa, Warwickshire CV32 4HY, UK
Name
First Names
Male/Female
Date of Birth
Address (Home)
State/Zip
Country
Telephone
Telefax
Company/University/Educational Name
Address
State/Zip
Country
Telephone
Telefax
Applicant Passport/Identity Number
Issued At
Visa required for Germany?
YES/NO
Student Status
Apprentice Status
Employed by
Position Held
Work or study description
If successful I agree to be bound by the conditions of the John C Hogg Travel Award
Signature
Date
IWMA Member Company supporting recommendation
Person Dealing
Signature
Date
Approved by Employer/College/University Official Name
Position
Signature
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WIRE & CABLE NEWS • Issue N° 41 – Autumn 2009 • www.iwma.org
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