Name of the organization: My_UA

Sending organization:

Name of the organization: My_UA
Address: Seminarska 2, Rivne region, Ostroh
Post code: 35800	Country: Ukraine
Tel.: [phone]	Fax:
e-mail: [e-mail]	Website:

Participant:

First name:	Last name:
Sex:	Date of birth:	Nationality:
Address:	Post code:	Country:
Tel:	Fax:	Mob:	e-mail:
What languages do you speak?	Do you have special needs (diets)?
In case of emergency:
Name	Last name	Tel:	e-mail:

If you need visa:

Passport number:
Date and place of issue of your passport:
Expiry date:
Name of issuing authority:
Place of birth:
Applying for the visa (city in your country)

We kindly ask you to answer the following questions; this information will help us to adopt the program to your needs.

1) Your general motivation for participation in this training course:

2) What do you expect to gain from your participation?

3) In which topics of the training course you are especially interested and why? See the attached programme.

4) How do you expect to use skills and knowledge received as the follow-up of the event?

5) What can be your own contribution to this training course?

6) Any other information/comments for the prep-team?

THANK YOUJ!

Please return this form to [e-mail] until 10/02/2015

We will inform you about your acceptance on 13/02/2015

Please don`t buy tickets before that!

Please make sure that you know that this training course has extra fee 50 euro

and we expect you to pay on your arrival.

Дата добавления: 2015-09-29