PROGRAM APPLICATION FORM Attach Your Scanned Photo CityNet Secretariat 10F, 38 Jongno, Jongno-gu, Seoul, R.O. Korea 03188 Phone: 82 2 723 0634 Fax: 82 2 723 0640 Web : www.citynet-ap.org E-mail: communication@citynet-ap.org Note: Please type in the form in English alphabets or tick(√ ), do not in hand-write for legibility “N/A” should be used where applicable. Do not leave any space blank. Ⅰ. PROGRAM : 17-22 April Fire Station Field Experience ( ) 23-29 April Life Safety and Fire Services Training ( ) Ⅱ. PERSONAL DATA : (First) (Middle) (Last Name) Date of Birth City/Locality Nationality Gender Religion Day Month Year M ( ) / F( ) e-mail Office Phone SNS(facebook, twitter, qq) Mobile Phone Chest measurements (Centimetres) Waist Measurements (Centimetres) (country code) (area code) Emergency Contact Name : Emergency Contact Number : Dietary Requirements : ※I don’t eat ※ VISA: I need an invitation letter to apply for entry visa issuance. Yes ( ) / No( ) Ⅲ. EMPLOYMENT AND EDUCATION Present Position/Title: Department or Division: Name of Organization: Address: Type of Organization: - City/Local Government ( ) - Autonomous Institution of City/Local Government ( ) - Other ( please specify : ) Term of Employment: from ( ) to present

Ⅲ. EMPLOYMENT AND EDUCATION (Continued) Describe your present duties : Training experiences in Korea (if any) Yes ( ) No ( ) If “Yes” Please Specify Name and Period of Program : Organized by : Ⅳ. ENGLISH LANGUAGE PROFICIENCY *Please tick(√) the box. Excellent Good Fair Poor Remarks Listening Speaking Writing Reading V. STATEMENT OF MOTIVATION AND WHAT YOU WANT TO LEARN 1. State your motivation to participate in this training program: 2. Describe your expectation from this program : 3. For the purposes of preparing materials for training, specify your clothing size: Circumference of your chest (cm): Waist size (cm or inches):

APPLICANT'S RESPONSIBILITIES If accepted as a participant, I agree: To follow the training program to the best of my ability and abide by the rules of the CityNet and Seoul Metropolitan Fire and Disaster Headquarters(SMFDH) during the training program; To refrain from engaging in political activities, or any form of employment for profit or gain; To return to my home country upon completion of my training program and to resume work in my country; To accept that the CityNet and SMFDH is not liable for any damage or loss of my personal property; and To acknowledge that the CityNet and SMFDH will not assume any responsibility for illness, injury, or death arising from extracurricular activities, willful misconduct, or undisclosed pre-existing medical conditions. To copy, transform and redistribute the submitted documents in any medium and format. Applicant's Name: Date : Signature:

LETTER OF RECOMMENDATION Dear Head of CityNet and SMFDH: Upon understanding goals and objectives of your international training program and with the hope of promoting our knowledge and experience exchanges, I hereby recommend the following person as our city’s representative in your program. I guarantee that our applicant will abide by all laws and rules of your city during the program period and will resume his/her job upon completing the course. Applicant’s Profile • Name of Training Program : • Applicant’s Name : • Present Position : • Department or Division : • Name of Organization : Recommender’s Profile • Recommender’s Name : • Contact Information - Tel - E-mail (We may contact you during applicants’ selection process) Date: Signature: