Please fill in all the fields included in this application form before June 26th 2015 and send it by email: [e-mail]

APPLICATION FORM

Please fill in all the fields included in this application form before June 26^th 2015 and send it by email: [e-mail]

PERSONAL DATA
Name
Surname
Sex (male/female/undefined)
Birth date (day/month/year)
Email
Telephone (private mobile)
Residence (Country, City)
Please write down your emergency contact person (name surname, phone and e-mail)

ORGANISATION
Full name
Website
Your position in the organisation

OTHER INFORMATION
Special requirements (special diets (e.g. vegetarian, vegan celiac disease), disabilities, allergies etc.)
Other Special Notes & Needs (if any)

EXPERIENCE AND EXPECTATIONS Please expand the rows accordingly, but make sure the entire registration form does not exceed 2 pages.
Please describe your motivation to participate
Please shortly describe your experience and involvement in historical reenactment
What do you expect to learn?

CONSENT OF PRIVACY	(please click in box)
I hereby agree for processing the following personal information strictly for the purposes of the Erasmus+: KA1 MLS Youth Mobility project: “ Antiquity and the Middle Ages Games! ” in accordance with the regulation for the protection of personal data passed on the following day: 29.08.97r. DzU nr 133 poz. 883.
I hereby permit Fundacja Instytut Działań Twórczych to use my image for the purpose of activities undertaken within the scope of " Antiquity and the Middle Ages Games project. The permission includes use, recording, processing and reproduction of photographs and films via digital and printed media.

If you have any questions please do not hesitate to email us: [e-mail]

Дата добавления: 2015-08-28