Application Form - Training Course Agents of Change April 2019
By filling in this application form, you are applying for participation at the Training Course Agents of Change, which will take place in Chata Doubravka near Chotěboř, Czech Republic between 15th and 25th April 2019 (incl. travel days).
We will contact you as soon as possible to confirm we got your application form and when approximately will we confirm if you are selected. Then, we will communicate the details.
If you have any questions, please contact coordinator Lenka Polcerová on
Your name and surname *
E-mail Address *
Telephone number (with country prefix) *
Date of Birth *
Permanent Address *
Country of residence *
Nationality (if different from the country of residence)
Temporary Address
If you already think you may go to the Training Course from a different place, that from your permanent address, please let us know by inserting the address you'll be most probably going from (or at least town + country :) )
Name you want to be called during the training
In case you'd like to be called in a specific manner by the team and the other participants - we will prepare name tags.
Special Needs *
If you have any special needs regarding accommodation, activities, alergies, access - let us know here so we can count on it in advance.
Food requirements *
If you have any combination of these or any special diet/what you don't eat, please, specify below in comments.
Which partner organisation do you represent? *
I agree with processing my personal data for the purposes of the project administration and implementation. *
Any comments to this section?
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