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Дата публикации28.07.2013
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Application form

Y-E-N seminar “Springboard to Inclusion – Innovative Youth Initiatives in the Balkans”

2nd– 8th June 2012, Groznjan, Croatia

(Arrivals on the 1st - departures on the 9th)



PARTICIPANT INFORMATION


NAME




SURNAME




MALE

FEMALE

DATE OF BIRTH




NATIONALITY




DIETARY REQUIREMENTS & SPECIAL NEEDS (food, disability, allergies, etc.)






^

HOME ADDRESS


HOUSE/FLAT NUMBER




STREET




CITY




POSTAL CODE




COUNTRY




MOBILE PHONE

00

FAX

00

EMAIL






^

PARTICIPANT’S ORGANISATION ADDRESS


Organisation name




Street




Postal code




City




Country




Telephone

00

Fax

00

E-mail




Website




Contact person






^

INVITATION LETTER NEEDED FOR VISA (IF APPLICABLE)


Passport number







Issued







Valid







Fax of Croatian Embassy/Consulate in your country











Please describe your work or responsibility in your organisation (maximum 5 lines):




































Please state your interest and motivation for attending this seminar (maximum 5 lines):


































Can you give us examples of specific groups of young people from your local community which are in need of projects on social inclusion? Are you involved in any local project for that target group? If not, do you have any project ideas in that field?


































How do you plan to multiply the results of this seminar in your organisation, in your community?


















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

  • preparing myself carefully for the seminar

  • taking part for the full duration of the seminar

  • participating 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 « Springboard to inclusion » seminar and the pictures taken during the « Springboard to inclusion » seminar.
Place : Date: Signature:








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