Work camps

Application form for Participation in International Multi-Disciplinary Work camps
Mandatory fields are marked with *

Family name *
Given names *
Sex *	Male: Female:
Date of Birth (dd.mm.yyyy)*
Nationality *
Present occupation *
Area of Specialisation *
if student, state subject area
Adress: *
Postal code: *
City *
Country *
Telephone: *
Mobile phone:
Work phone:
Email address:

Emergency contact (phone number) / name of the contact person whilst you are away on the project *

Passport number (Check visa requirements for chosen project location) *

Give details of your voluntary / community work experience including work camps if applicable *

Reason(s) for participation in workcamp *

What do you think you can contribute to the workcamp as a volunteer? *

Mother tongue *

Other languages you speak. Please indicate Fluent, Good, or Basic.

Special Dietary needs, e.g. vegetarian, Religious, Medical reasons

Any serious accidents, illnesses, disabilities, allergies


Workcamps chosen in order of preference: *
	Kitale and 20-25 Surrounding town and villages in north western Kenya. - Period: 5th August - 16th August 2010
	Monrovia and 15-20 surrounding villages in Liberia - Period: 27th June to 18th July 2011 (next year)
	Bekoko Village, Cameroon School building, teaching and School health programme - Period: 27th June - 19th July 2011 (next year)
Estimated time you can afford to volunteer at the Workcamps *

Why do you choose this particular workcamp?

What do you expect from it? *

Please if the given address above is a temporary one, kindly write your permanent address. If necessary, please indicate the dates within which this address is valid.

I declare that I have read through the conditions to participate in AEMRN workcamps conditions of participation.