548 Jean-Talon Ouest, Montreal, Quebec, Canada H3N 1R5 

E-mail: fsc@grassrootsglobal.net, info@grassrootsinstitute.net

Websites: www.grassrootsinstitute.net, www.grassrootsglobal.net

Summer Field School [Online] on

MOUNTAIN ECOSYSTEMS AND RESOURCE MANAGEMENT
Ivano-Frankivsk Region, Ukraine :: 19-28 September, 2021

REGISTRATION FORM
(FOR LEARNER PARTICIPANTS)

INSTRUCTIONS: Please submit your completed application as an email attachment to fsc@grassrootsglobal.net

Before sending, please be sure that you have entered your name and contact details correctly. Once your
application is received COMPLETE, we will notify you with the receipt of your application. In case of any problem,
query or issue, you may contact us. However, we will recommend reading the information on the website
www.grassrootsglobal.net/mer2020 thoroughly. Please note that website information was placed before the
decision was taken to conduct the program in Online Mode due to unending global pandemic.

A. Contact Information
Prefix: Mr./Ms./Dr./Mrs./Sir Date of Birth:      
Full Name:       Designation:      
Name of Organization/Institution:      
Current Full Address:      
WhatsApp/Viber Phone #:       Correct Email ID:      

B. Highest Education (tick)

Bachelor’s degree
PG Diploma
Master’s degree
PhD
Postdoc/Doctorate
Other, specify:      

C. Declaration from the Applicant (please tick the boxes)

The information provided above is true and correct.

I understand, read and write English in order to participate International Participatory Academy.

Signature (your full name will be considered as your signature) Date

The completed Registration Form should be sent by e-mail to: fsc@grassrootsglobal.net

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