1st ASECU Youth WINTER SCHOOL
Application Form
First name *
Your answer
Middle name
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Last name *
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Student or Teacher? *
Sex *
Date of Birth *
MM
/
DD
/
YYYY
Affiliation *
Univeristy, Department
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Major (for students and PhD students)
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Address *
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City *
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Zip *
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Country *
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Email *
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Tel. *
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Passport Number
100-200 words
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Identity Card Number
100-200 words
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Origin (as is mentioned in the document)
100-200 words
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Travel information
Date of arrival
MM
/
DD
/
YYYY
Date of departure
MM
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DD
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YYYY
Means of transport
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Do you need a Visa to enter Poland?
Additional information
Indicate any special dietary needs or/ and food preferences (if applicable): *
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