Fostering Intercultural Dialogue Through Architectural Heritage and Visual Arts

Fostering Intercultural Dialogue Through Architectural Heritage and Visual Arts

Rustavi, Georgia, July 11-18 2013

PARTICIPANT APPLICATION

Arrival: July 11 by lunchtime

Departure: July 18 any time

Name & Surname:
Name of the organisation and Country:
Citizenship:		Date of Birth:		Gender:	Female Male
Passport validity date:
Address:
Postcode:		Town:		Country:
Mobile Phone [with full international area codes]		Skype:
Email:		Website:
Your estimated ARRIVAL	Your estimated DEPARTURE
Date (D/M/Y)	Time (Tbilisi Time)	From (City, Country)	Transit City (In transit Cases)	Date (D/M/Y)	Time (Tbilisi Time)	To (City, Country)	Transit City (In transit Cases)

Please indicate the price, currency and date of purchase of your ticket (s):
Please, indicate with X your English proficiency:	Fluent	Average
Basic	Poor
Do you have any special needs or dietary requirements that the host organization should know about? (E.g. mobility, medical needs, allergies, dietary restrictions, smoker/none smoker etc.)

Please indicate the name and full contact details of a person to be contacted in case of emergency during the training:

Name:
Complete address:
Postal code:		Town:		Country:
Phone:[with full international area codes]		Fax:[with full international area codes]
Email:

Please answer following questions about your motivation, expectations and dissemination:

Please describe with few sentences your role within the organisation.

Why do you want to participate in the seminar?

What do you expect to gain from your participation?

The completed application form must be sent to:
[e-mail]

By June 10th 2013

Дата добавления: 2015-11-04