" 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

First Name

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Personal Information

Last Name

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ID/Passport No

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Contact No. (mobile)

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E-mail

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Gender

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Date of Birth

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Nationality

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About Your Organisation

Organisation Name

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Type

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Website

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Contact Person

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Phone

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Email Address of Contact Person

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Please give a short summary of your organization

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Please explain your role in the organization and list your participation with it within the last 2 years

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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 )

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Do you have an experience with Loesje methods

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If yes , Then please describe

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What makes you qualified for Loesje Training? ( Skills/Projects/Work/Study)

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Motivation, Expectations and Follow Up

What is your motivation for participating in this training? What do you expect to gain from this Training?

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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

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How will you (and your organization) work to develop and use Loesje Methods?

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Level of English

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Other Languages

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Visa Information

Please fill out only if you require a Schengen visa to enter Germany , Else you can write NA

Name on PASSPORT

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Passport Number

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Date of Issue

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Date of Expiration

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Place of Issue

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City/Country of Birth

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Address of the embassy where you plan to apply for visa

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Embassy email, telephone and fax number

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The Visa invitation should be sent to your above address

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If no , Please write the address that the visa should be sent to

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Special Needs and Dietary Requirements

Please indicate any special needs that we should take into account (e.g. dietary, disability, medications/ etc.)

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Appointment at Embassy ( Number , Date, Time )

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" Future- Let's Just Do It " PARTICIPATION FORM - Egypt

Personal Information

About Your Organisation

Your Experience

Motivation, Expectations and Follow Up

Visa Information

Special Needs and Dietary Requirements

By Pressing Submit , I certify that the above-mentioned information is correct and I commit myself to participate actively in the Training