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* 1. The Permanent Representative of

designates the following expert as a National Public Weather Services Focal Point

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* 2. Title

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* 3. Gender

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* 4. Family name / Surname

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* 5. First name / Given name(s)

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* 6. Organization

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* 7. Mailing address

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* 8. Position

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* 9. Responsibility

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* 10. Telephone

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* 11. Mobile

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* 12. Email

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* 13. Fax

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* 14. Date of birth

Date

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* 15. Endorsement from the Permanent Representative (PR)
(adding the name of the PR below is recognized as official signature so this should be done with the PR's approval):

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