FEEC 10117
Full Name:
Residential Address:
Current Occupation:
Contact Details
Phone:
Email:
1. Why would you like to attend the workshop on Polling, Counting and Results?
2. How will this workshop on Polling, Counting & Results module benefit:
a. You as an individual?
b. Your community?
c. Your country?
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FEEC 10117
3. Declaration:
Declaration
I ______________________________________________________________________________________________________
(Full name: (first or given names and family or surname)
of _____________________________________________________________________________________________________
(Full residential address)
solemnly and sincerely declare that:
1. I understand the politically sensitive environment of the Fijian Elections Office and
declare that I am not affiliated or plan to be affiliated with any political parties in Fiji; and
2. I will treat all information in whatever form pertaining to the Fijian Elections Office in
strict confidence.
Signature: _______________________________ Date: __________________
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FEEC 10117