Jury Registration Form Personal Information English Arabic Jury

Jury Registration Form Personal Information English Arabic Jury Name Organization Type □ Government □ Private □ SME □ Association or Society □ Others □ ﺣﻜﻮﻣﻴﺔ □ ﺧﺎﺻﺔ □ ﻣﺆﺴﺴﺔ ﺻﻐﻴﺮﺓ ﻭﻣﺘﻮﺳﻄﺔ □ ﺟﻤﻌﻴﺔ ﺃﻮ ﻣﺆﺴﺴﺔ ﻣﺪﻧﻴﺔ □ ﺃﺨﺮﻯ Designation Nationality ID/Passport Number Email Contact Area of Expertise : (max 50 words) Arabic Language Fluency Basic Good Speaking Excellent Basic Writing Good Excellent List most recent positions held (maximum 3) Organization Designation List main academic qualifications (maximum 3) Organization Qualification 12 - 1 From To Business Activity Year

List latest 3 relevant professional qualifications Organization Qualification Year 123 List prior experience in Award Jury or Assessment (maximum 3) Award name Award Organization Year Role (Jury/Lead Assessor/ Assessor) 123 List relevant memberships (maximum 3) Membership Title Awarding Body Year Awarding Body Website URL 123 - Availability Please accept to be available on following dates: Online remote evaluation Jury on site sessions 13 th-16 th December 2017 Logistics Please specify if an Entry Visa is required I confirm all information provided is an accurate record of my professional history to date □ 2