REGISTRATION FORM FOR                              TWO WEEKS TRAINING PROGRAM                              IN BARKA’S NETW...
4. Dietary RequirementsSpecial dietary requirements:I am non-vegetarian/vegetarian/other (please specify): _______________...
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Registration form august

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Registration form august

  1. 1. REGISTRATION FORM FOR TWO WEEKS TRAINING PROGRAM IN BARKA’S NETWORK IN POLAND 5th – 17th of August thPlease complete and return by e-mail to the address maria.sadowska@barka.org.pl by 27 of July.1. Participants informationFamily name:________________________________________________________________Title:_______  Prof.  Dr.  other:_________________________ Mr.  Ms.  Mrs.First name:__________________________________________________________________Telephone:__________________________________________________________________Fax:_____________________________ E-mail:_____________________________________2. Information about the organization/institution you work forOrganization/institution name: __________________________________________________Address: ___________________________________________________________________City: _______________________________________________________________________Country: ___________________________________________________________________What does your organization/institution do? _____________________________________________________________________________________________________________________________________________________________________________________________3. Please write in a few sentences why you would like to participate in thistraining programme in Barka Poland (Why do you think it could be important to youand your work? What do you hope to gain from it?)______________________________________________________________________________________________________________________________________________________ 1
  2. 2. 4. Dietary RequirementsSpecial dietary requirements:I am non-vegetarian/vegetarian/other (please specify): ________________________________________________________________________________________________________5. Additional InformationPayment Information: The training program is free of charge. It is fully financed by theLeonardo da Vinci Mobility 2012 Program from which Barka IE received a grant.Comment on Participants: An individual can only profit once from a Leonardo funding in aPLM (people in the labour market) target group.The participant must be: - a national of a country participating in the Lifelong Learning Program; - a national of another country, who is enrolled in regular courses in schools or institutions of Vocational Training in a participating country, or employed or living in participating country.Europass Mobility: Europass Mobility will be awarded to all participants.Deadline: Please return completed registration form by 6th of July by e-mail to the addressmaria.sadowska@barka.org.pl. Please use one form per person. If you should have anyproblems registering or any other questions, please contact Maria Sadowska(maria.sadowska@barka.org.pl or phone +48 530 435 179).Confirmation: Please allow 3 days for e-mailed confirmation of your registration. 2

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