“Because we can – for future cooperation!”

REGISTRATION FORM

“Because we can – for future cooperation!”

19-23.09.2014

MOTYCZ LEŚNY N. Lublin, Poland

Personal Details
NAME (as in passport in Latin characters)
DATE OF BIRTH
EMAIL
GENDER	o female o male
LANGUAGE ABILITIES
Passport data (if visa is needed)	- Passport number - Date of issue – valid till

Professional Background
Position:	member
Organisation:	Name	League of Youth Voluntary Service
	Street	B.Chmialnickaha 4
	City	Minsk
	Postal Code
	Country	Belarus
	Phone	[phone]
	Fax	[phone]
	Website	www.lyvs.bn.by
	Email	[e-mail]

Motivation, Need, Knowledge
Why do you join the training course, both personally and professionally? What expectations do you have towards this training? If you have any, what is your experience in working within the Youth in Action Program/Erasmus+? Which kind of inclusive projects do you have in mind? Do you know any? (Best practices, etc.)
Special Needs or Requirements: o Please let us know if you require any special arrangements or if there are things we need to be aware of.(e.g. vegeterian, allergies,…)
EMERGENCY CONTACTS Please indicate us the name and full contact details of a person to be contacted in case of emergency during the course
Name:
Complete address:
Postal Code:	Town:	Country:
Phone [with full international dial codes]:	Email:
Please take note of the following conditions that will apply if you are selected to take part in the training course. 1. I commit myself to participate in the whole process, including: · to prepare myself carefully for the training course and to do all remote preparation work the team will ask for, · to take part in the full duration of the training course · to participate in the whole evaluation process 2. 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 I provided on my special needs does not remove my own personal responsibility for ensuring my own health.

Дата добавления: 2015-08-27