Participation Form

IAEA

International Atomic Energy Agency

Atoms for Peace and Development

Participation Form

Form A

EVT1904780

International Workshop on Emergency Consequence Management

Virtual Event 15 to 19 March 2021

To be completed by the participant and sent to the competent national authority (e.g. Ministry of Foreign Affairs, Permanent Mission to the IAEA, or National Atomic Energy Authority) of his/her country for subsequent transmission to the International Atomic Energy Agency (IAEA) either by email to: [e-mail] or by fax to: [phone] (no hard copies needed). Please also send a copy by email to the Scientific Secretary, Mr Maxwell Daniels, Incident and Emergency Centre, Department of Nuclear Safety and Security (Email: [e-mail] ) and to the Administrative Secretary, Ms Oksana Veremiy Krznaric (Email: [e-mail] )

Deadline for receipt by IAEA through official channels: 26 February 2021

Family name(s): Yo’ldashev		First name(s): Firdavs	Mr/Ms: Mr
Institution: Institute of Nuclear Physics of Academy of Sciences of the Republic of Uzbekistan
Full address: Huroson street 1, Settlement, Ulugbek, Tashkent 100214, Uzbekistan
Tel. (Fax): [phone]
Email: [e-mail]
Nationality: Uzbekistan	Representing following Member State/non-Member State/entity or invited organization: State Committee on Industrial Safety of the Republic of Uzbekistan.
If/as applicable: D o you intend to submit a paper? Yes No W ould you prefer to present your paper as a poster? Yes No Title: