Application Form

Please read carefully the form and after completing it fully push the send button.

Name and surname*:

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* 1. Name and surname*:

E-mail address*:

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* 2. E-mail address*:

Phone:

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* 3. Phone:

Address*:

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* 4. Address*:

Grade*:

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* 6. Grade*:

School or instution*:

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* 7. School or instution*:

Thesis advisor or a reference*:

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* 8. Thesis advisor or a reference*:

What week(s) will you attend?

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* 9. What week(s) will you attend?

  Week
Week of 18 June
Week of 25 June
City and country*:

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* 10. City and country*:

If you need financial support please tell us the daily amount you need:

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* 13. If you need financial support please tell us the daily amount you need:

Person to be contacted in case of emergency (mail and phone)*:

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* 14. Person to be contacted in case of emergency (mail and phone)*:

Special conditions*:
Alergy, phoby, physical or psychological problems, special diet, etc.

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* 15. Special conditions*:
Alergy, phoby, physical or psychological problems, special diet, etc.

Notes:

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* 16. Notes:

The fact that you filled and sent this registration form means that you agree and comply with the conditions set by the Village. These conditions can be found at this address
Department

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* 17. Department

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