Departure: 12 th In the morning

Youth Exchange

Choose Peace!

5-12 April, Kobuleti Georgia

Arrival: 5th of April

Departure: 12 th In the morning

Name & Surname:

Name of the organization and Country:

Nationality:

Date of Birth:

Gender:

¨Female ¨Male ¨ Other

Complete address:

Postal code:

Town:

Country:

Mobile Phone [with full international dial codes]

Skype:

E-mail:

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)

Do you have any special needs or dietary requirements that the host organization should know about? (E.g. medical needs, allergies, dietary restrictions, smoker/non-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 dial codes]		Fax: [with full international dial codes]
Email:

Please, answer following questions:

Background

Have you ever participated in any Youth in Action programme?

If yes, please give details.

Motivation and Expectations

Why do you want to participate in this Youth exchange?

What kind of knowledge & skills would you like to gain by participating in this Youth exchange?

Please fully complete all sections of the form and send it by

18 of March

To [e-mail]

saved with the following title: Country_Name_Surname

We thank you for your interest in this project and look forward to receiving your application form.

Дата добавления: 2015-09-29