Ahmed Al-Jaber Street, Plot 1

Commercial Bank Bldg., 2nd Floor

Opposite Al-Awadhi Mosque
Sharq, Kuwait
Mail: PO Box 44818
Hawalli 32063, Kuwait

Phone: +965-2247-0091
Fax: +965-2247-0092; +1-202-776-7109 (in U.S.)
Email: kuwait@amideast.org
Website: www.amideast.org/kuwait

SECTION 1: Registration Information

1. First Name

2. Last name / Family Name

Date

Month

Year

SECTION 2: Contact Information

1. Company Name: __________________________
2. Mobile Phone

3. Office Phone

4. Fax Number

5. Email Address:

__________________________

6. Signature:

__________________________

11. Date: _____________________