" Future- Let's Just Do It "  PARTICIPATION FORM   - Egypt                                    
Venue : Berlin, Germany 23.01.2015 – 30-03.2015      
This form must be completed in English by 30th January 2015

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First Name *
Personal Information
Last Name *
ID/Passport No *
Contact No. (mobile) *
E-mail *
Gender *
Date of Birth *
Nationality *
About Your Organisation
Organisation Name *
Type *
Website *
Contact Person *
Phone *
Email Address of Contact Person *
Please give a short summary of your organization *
Please explain your role in the organization and list your participation with it within the last 2 years *
Your Experience
Please provide information regarding your current work/study and your main tasks/responsibilities within your organization  (if different from above) (max 5 lines ) *
Do you have an experience with Loesje methods *
If yes , Then please describe  
What makes you qualified for Loesje Training?  ( Skills/Projects/Work/Study) *
Motivation, Expectations and Follow Up
What is your motivation for participating in this training? What do you expect to gain from this Training? *
Please explain how you would contribute to the training (main ideas you would like to express and/ or good practices you would like to share) Maximum 8 lines *
How will you (and your organization) work to develop and use Loesje Methods? *
Level of English *
Other Languages
Visa Information
Please fill out only if you require a Schengen visa to enter Germany , Else you can write NA
Name on PASSPORT *
Passport Number *
Date of Issue *
Date of Expiration *
Place of Issue *
City/Country of Birth *
Address of the embassy where you plan to apply for visa *
Embassy email, telephone and fax number *
The Visa invitation should be sent to your above address *
If no , Please write the address that the visa should be sent to
Special Needs and Dietary Requirements
Please indicate any special needs that we should take into account (e.g. dietary, disability, medications/ etc.)
Appointment at Embassy ( Number , Date, Time ) *
By Pressing Submit , I certify that the above-mentioned information is correct and I commit myself to participate actively in the Training
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