be ACtive, creaTIve, nOt discriminaTive!

ACTION be ACtive, creaTIve, nOt discriminaTive! 3rd to 12^th of May 2014, Zagreb, Croatia
Name and surname
Country of residence
Adress
Gender
Date of birth
Name you want to be called during the exchange
Phone number
E-mail address
Do you need a visa in order to travel to the Croatia?
Do you have a special diet? If yes, please mention what type of special diet (vegetarian, vegan, allergies etc)
What is your present health condition? If you have any health problems please mention them here and describe any medication you take or have taken in the last 6 months.
Contact person in case of emergency: *	Full name:
Relationship to you:
Address:
Telephone number:

Do you have a medical insurance valid in Croatia?
Do you need visa to enter in Croatia?
Passport number: (only if you need visa)
Date of issue: (only if you need visa)
Place of issue: (only if you need visa)
Place of birth: (only if you need visa)
Level of English:
Occupation or profession:
What is your motivation to be part of this exchange and what would you like to learn in it? Please explain in detail.
Have you participated in any international exchange before?
How did you find out about this exchange?
Other remarks or questions:

Date and signature___________________

Дата добавления: 2015-08-27