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REPUBLIC OF INDONESIA
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SPECIAL ASEAN LEADERS'
MEETING ON
AFTERMATH OF EARTHQUAKE AND TSUNAMI,
6 JANUARY 2005, JAKARTA CONVENTION CENTER (JCC)
MEDIA ACCREDITATION
APPLICATION FORM
| NAME |
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| ORGANIZATION |
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| POSITION |
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Reporter |
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Photographer |
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Technician |
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Other
(please specify) ..................................................................
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| BUSINESS
ADDRESS |
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| CONFERENCE
ADDRESS |
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| PLACE/DATE
OF BIRTH |
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| PASSPORT
NUMBER |
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| NATIONALITY |
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| PRESS
CARD NO. |
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| ISSUING
AUTHORITY |
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| Enclose
a letter of assignment from Editor/Executive
of Organization and two current color
photographs (3 x 4 cm) and return to
the Media
Secretariat no later than January
4, 2004.
For further information
please contact the Directorate for
Information & Media Services,
Department of Foreign Affairs of the
Republic of Indonesia through Mrs.
Irzani Ratni +62818088237508 at
phone : +62-21-3813453 ext. 4515,
phone and fax: +62-21-3440488; fax
: +62-21-3857316; and Mr. Triyogo
at phone: +62-8568746644, or e-mail
to fasmedia@deplu.go.id
website www.deplu.go.id
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EMBASSY
OF THE REPUBLIC OF INDONESIA
8 Darwin Avenue, Yarralumla, Canberra, A.C.T.
2600
AUSTRALIA
Tel. +612 6250 8600, Fax. +612 6273 6017
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