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Financial Institution Supervision Course Registration Form
Monday, May 12 - Thursday, May 15, 2014
Please use the "Sentence case" format to complete the form, DO NOT use UPPERCASE format
  *Required
Salutation:*
Given Name:*
Family Name:*
Job title:*
Department:*
Central Bank Name:*
Business Mailing Address
Please provide your institution's full official postal address:
For example:
Street address or PO Box
City/Town/State/Province/Postal Code
*
*
  
Country: *
E-mail:*
    (confirm E-mail):*
Phone Numbers
For International numbers, please include country code and city code, if applicable.
 Country Code City Code Local Number
Phone:  *
Fax:  
Alternate Contact Information
Please provide a phone number and email address where you can be reached after leaving for the course. For International numbers, please include country code and city code, if applicable.
 Country Code City Code Local Number
Alternate Phone:   *
Alternate E-mail:     *
    (confirm Alternate E-mail):     *
Date appointed to current position:*
Please give a brief explanation of your current responsibilities.
*
This application will not be processed unless we receive a statement of endorsement from your governor. You will be advised of the status of your acceptance after the March 17, 2014 closing date.