" Empowering Youth Through EVS " Training Course                              
Venue : Lefkas , Greece 11.12.2014 – 21-12.2014      
This form must be completed in English by Sunday 19th October 2014

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Personal Information
First Name *
Last Name *
Postal address (street, number, city, post code, country) *
Contact No. (mobile) *
E-mail *
Gender *
Date of Birth *
ID/Passport No *
Please explain your role in the organization *
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 ) *
What makes you qualified for this Training? *
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 *
Level of English *
Other Languages
Visa Information
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 *
If no , Please write the address that the visa should be sent to
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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