RENEWING OUR MINDS 2020 - INTERNATIONAL GATHERING - Application
Event Timing: August 2nd-16th, 2020
Event Address: Fužinarska Kuća, Franje Račkog 30, 51322 Fužine, Croatia
Contact: forumforleadership@gmail.com
ROM 2017 small group discussion
1) First Name (as in passport) *
Your answer
2) Family Name (as in passport) *
Your answer
3) Gender *
4) Date of birth *
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YYYY
5) Marital status *
6) Email *
Your answer
7) Email #2
Your answer
8) Mobile phone number (+38....) *
Your answer
9) Occupation *
Your answer
10) Employer (Address, email, phone, phone number) *
Your answer
11) Level of English (intermediate or higher level is required for program participation) *
12) What is the highest level of education you have completed? *
Required
13) Please provide the name of your university, graduation year (or expected year of graduation if you are still studying), and your field of study. *
Your answer
14) Please specify any additional or continuing education classes or conferences you have attended related to leadership, reconciliation, peace-building and/or social activism. *
Your answer
15) Please, explain your reasons for applying to attend the ROM 2020 Gathering? *
Your answer
16) What do you personally hope to gain by attending the ROM 2020 Gathering? *
Your answer
17) How do you plan to use and apply the ROM 2020 experience upon returning home to your community? *
Your answer
18) Are you currently involved in any leadership development, reconciliation, social activism or other community building activities? If so, please describe these activities. *
Your answer
19) Please list any hobbies, skills and special interests that you feel could contribute to the ROM 2020 program (i.e., music, drama, sports) *
Your answer
20) Is there anything else that you want the ROM leadership team to know about you when considering your application?
Your answer
21) Please provide the names of two references, along with their relationship to you, occupation, and contact information (email address and phone numbers): *
Your answer
22) Please tell us how you found out about the ROM 2020 Gathering. *
Required
23) If you found out about ROM through a previous participant or speaker, please list their name and your relationship to them:
Your answer
24) Do you have any medical conditions that would require special attention? (this will stay confidential) *
25) Do you have any dietary needs or preferences – either medical or religious? *
Required
26) In the unlikely case of an emergency, whom should we contact: (Name, relationship to you, and mobile phone number) *
Your answer
27) I understand that: *
Required
28) I understand that the full cost of accommodations, food, and program for ROM 2020 is 1000€ per person, and that participants from Western countries are asked to pay this full amount.
29) I understand that early bird prices are for the Balkan participants only: February 125€, March 135€, April 145€, May 155€, June 165€, July 175€, August 185€ (provided a deposit of €25 at paypal.me/forumforleadership by the end of the month). *
Required
30) Any other comments regarding payment:
Your answer
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