Name Badge and Mailing Information (use a separate form for each person)

Name  _____________________________________________ 

Badge Name   ________________________________________  

(this name will appear on your name badge)

Title    ______________________________________________

Department/Unit______________________________________

Institution/Organization_________________________________

Mailing Address________________________________________

City_________________________  State/Prov.  ____________

Postal Code  __________Work Phone        _________________

Fax  ____________________     E-mail  ____________________

For Registration Information

please contact +971 4 3326666. 

To register, please copy the above given regn. form and e-mail your completed form to    Zayedprz@emirates.net.ae 

Thank you! We look forward to seeing you in Dubai in April!  www.zayedprize.org.ae