Contact making seminar

,,East & West connected by EVS

01 December 2014 08 December 2014
a!"og region, #$"garia
1
APPLICATION FORM
Please type and return by email or write in capital letters and
return
e-mail by Contact Details
First Name: Last Name:
Postal address (street, number, city, postal code, country):via Napoli n.18
Telephone: Telefax:
Mobile telephone: -mail:
!ender: Male / Female "#e: Nationality:
$% &r#anisation or 'nstitution
Name:
Postal address:
Telephone: Telefax:
-mail:
(eb-pa#e:
Please describe the community/organisation you represent and briefy the scope and its
activities
our role in the organisation:
How you are involved in EVS:
)% *elation to the seminar themes
!hat is your personal/pro"essional e#perience in relation to the theme o" the $eminar%
!hat previous &ouncil o" 'urope, outh in (ction or any other international youth activities
have you attended% Please speci"y name o" activity and dates%
2
+% Moti,ation
!hy )ould you li*e to participate in this seminar%
+o) )ill your organisation bene,t "rom your participation at this seminar%
-% .pecial needs
-o you have any special needs or re.uirements that the organisers should ta*e into account
(e.g. dietary, disability, etc.)%
/% Tra,el details
Route and means of transportation:
Arrival airport/city and time:
Departure airport/city and time:
Travel costs in !"A "#RRE$"%:
"omments:
-M"'L 0&1* "PPL'C"T'&N T&: alternati,i%international2#mail%com
T3"N4 0&15
%