Application form




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Дата конвертації01.11.2013
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Application form

Answers in the Mirror

12 – 18 September 2013, Ankara,Turkey

(Arrival on the 12nd - Departure on the 18th)



PARTICIPANT INFORMATION


NAME




SURNAME




MALE

FEMALE

DATE OF BIRTH




NATIONALITY




SPECIAL NEEDS (food, disability, allergies, etc.)







^

HOME ADDRESS


HOUSE/FLAT NUMBER



STREET




CITY




POSTAL CODE




COUNTRY




MOBILE PHONE




EMAIL






^

PARTICIPANT’S ORGANISATION ADDRESS


Organisation name




Street




Postal code




City




Country




Telephone




E-mail




Website




Contact person






^

PLEASE DESCRIBE YOUR WORK OR RESPONSIBILITY IN YOUR ORGANISATION (MAXIMUM 5 LINES):









PLEASE STATE YOUR INTEREST AND MOTIVATION FOR ATTENDING THIS TRAINING COURSE (MAXIMUM 5 LINES):






Please take note of the following conditions that will apply if you are selected to take part in the « Answers in the Mirror » training course :
I commit myself to participate in the whole process, including:

  • to prepare myself carefully for the training course

  • to take part in the full duration of the training course

  • to participate in the whole evaluation process


I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expenses. I understand that the information provided on my special needs does not remove my own personal responsibility for ensuring my own health.
I authorise the teamers to publish, in whatever form and by whatever medium, including the internet, the outcomes of the « Answers in the Mirror » training course and the pictures taken during the « Answers in the Mirror » training course.
Place : Date: Signature:


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