International Public Speaking Competition 2012Monday 14 May 2012 – Friday 18 May 2012

Participant Information Form

Participants should complete this form and submit it via e-mail to ipsc@esu.org by Friday 6 April 2012

Country Speech Title

Participant Personal Information

First Name(s) / Given Name(s) Surname(s) / Family Name(s) Date of Birth (dd/mm/yy) Gender (M/F)

Participant Contact Information

Home Telephone Number Mobile / Cell Number Mailing Address E-mail Address

Participant Travel Information1

Arrival Date / Time Arrival Airport Arrival Airline / Flight Number Departure Date / Time Departure Airport Departure Airline / Flight Number

Participant Additional Information

Dietary Requirements (if any) Allergies (if any) Other Requirements (if any)

1 Please contact the IPSC Convenor if you require a letter of invitation for your visa application.

Emergency Contact Information

Emergency Contact First Name(s) / Given Name(s) Emergence Contact Surname(s) / Family Name(s) Emergency Contact Home Telephone Number Emergency Contact Mobile / Cell Number Emergency Contact E-mail Address

Accompanying Guest Information2

Accompanying Guest 1 First Name(s) / Given Name(s) Accompanying Guest 1 Surname(s) / Family Name(s) Relationship to Participant

Accompanying Guest 2 First Name(s) / Given Name(s) Accompanying Guest 2 Surname(s) / Family Name(s) Relationship to Participant

Additional Information

1. All participants should read the IPSC 2012 competition handbook in advance of the competition. The handbook has been sent to all National Competition Organisers and is available to download from esu.org/ipsc.

2. All participants will be provided with accommodation for the duration of the IPSC 2012 programme and will share with another participant of the same gender.

3. All participants are required to attend each of the activities, events and excursions which form part of the IPSC 2012 programme.

2 Two accompanying guests per participant are eligible to attend IPSC 2012. “Accompanying Guest” (for the purposes of the IPSC and the competition handbook) means a guest who has submitted the accompanying guest information form and paid the accompanying guest registration fee. The accompanying guest registration fee is £300 (twin room) or £450 (single room). Please ensure that a separate accompanying guest information form is submitted for each accompanying guest listed above.