EXPLORING NEW SHORES - APPLICATION FORM
Training course for youth workers, youth leaders and young people dealing with the topic of change.
Use the time of change or challenge as a chance for personal growth!
22nd - 28th April 2013, Beskydy Mountains, Czech Republic
Hotel Ameryka:    www.hotelameryka.cz/en

If you are interested in our training course, please fill in the questions below.
Filling in might take about 30min so make sure you are not under time pressure:)

Thanks a lot for your interest, in case of any further questions please contact us at exploringnewshores@gmail.com,

Your trainers team: Bara Blahova, Oliver Schneitter, Gabi Steinprinz
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PERSONAL DATA:
First Name:
Family Name:
Date of birth:
Gender:
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PLEASE, INDICATE SPECIAL NEEDS AND REQUESTS (DIET, VEGETARIAN, HEALTH, DISABILITIES, RELIGIOUS NEEDS, ETC.):
LANGUAGE PROFICIENCY: English
The program of the training coursse will be in English. It is neccessary for you to be able to communicate in English to take part on the training course.
fluent
basic
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Other languages spoken:
What other languages do you speak? What is your mother tongue?
PRIVATE ADDRESS:
STREET AND STREET NUMBER:
POSTAL CODE AND PLACE:
COUNTRY:
E-MAIL:
MOBILE PHONE NO:
ORGANISATIONAL DETAILS:
IF YOUR ARE INVOLVED (VOLUNTEERING, WORKING ETC) IN AN ORGANISATION , PLEASE FILL IN THE QUESTIONS BELOW.  
If not, go to the next page - MOTIVATION FOR PARTICIPATION.
Organisation name:
Address of your organisation:
STREET AND STREET NUMBER:                POSTAL CODE AND PLACE:                      COUNTRY:
Contact email of your organisation:
Webpage of your organistion:
MAIN ACTIVITIES AND TARGET GROUP OF YOUR ORGANISATION:
Please describe briefly what does your organisation do and how are you personally involved in those activities:
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