Application form for APV
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Email *
Name (written as in your passport) *
Surname (written as in your passport) *
Date of Birth *
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DD
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YYYY
 Which gender do you associate yourself with? *
County of Residence *
Required
Postal Address *
(street, number of building, city/village, postal code)
Emergency contact (please provide name, relationship and contact information) *
Mobile phone *
Facebook profile *
Do you have any special needs or requirements (e.g. dietary, disability, etc.)? *
Name of sending organisation/institution/ formal or informal group/network *
What is your role in the organization? *
Have you participated in the training course within the project "Speak Peace not Hate" in UK on 7-14 June 2018 *
Date of Arrival to Ukraine for APV *
MM
/
DD
/
YYYY
Time of Arrival *
Time
:
Airport of Arrival *
Date of Departure *
MM
/
DD
/
YYYY
Time of Departure *
Time
:
Airport of Departure *
Means of travel from city of arrival to Sumy *
By fill in this form I accept that organizers can use my personal data for the purpose of project and I accept to receive e-mail from Centre of Innovative Approaches CIC and Center for Euroinitiatives. *
I give my permission for using photos and videos with me made within the project for project dissemination *
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