Application Form
For the Activities of the Project BASE "Be active - Shape Europe"
Name *
Surname *
E-mail *
Sex (Male, Female, Other) *
Date of Birth *
Country of Residence *
Activity of Interest *
Please briefly explain us the reason you wish to participate to the activity-ies you have chosen (max. 100 words)
A photographer and/or a film crew will be present in the events rooms to film the event for illustration and information purposes related to the activities, projects or events of the organizers. The event may also be web streamed and recorded. Recordings will be visible to the public. Speakers, trainers or participants to BASE project' events who do not agree to photographing, filming and use of their image and voice have to inform the organizers before they complete their registration, at the following email address: By accepting to participate at the event, you confirm that you agree with the privacy statement and copyright information and you consent that the organizers may use your data, email, image and voice collected within the context of the event, as described.
Please check the " I Agree" box to proceed to the Final Submission *
I certify that the information given on this application form is correct and that I have included all relevant information.
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