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

Address (2000 Caractères gauches) *

Postal Code *

City *

Country *

Telephone

Mobile Phone

Work phone

Email *

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 (2000 Caractères gauches) *

Reason(s) for participation in workcamp (2000 Caractères gauches) *

What do you think you can contribute to the workcamp as a volunteer? * (2000 Caractères gauches) *

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

Kitale, Kiminini, Bungoma and 20-25 Surrounding town and villages in north western Kenya, East Africa. Period: 30th July – 8th August 2012. Choose 1 Priority 2 Priority *

Lusaka, Zambia: 15-20 surrounding towns and villages 45 km South East of Lusaka. Period: 23rd July – 28th July 2012. Choose 1 Priority 2 Priority *

Estimated time you can afford to volunteer at the Workcamps *

Why do you choose this particular workcamp? (2000 Caractères gauches)

What do you expect from it? (2000 Caractères gauches) *

If necessary, please indicate the dates within which this address is valid. (2000 Caractères gauches)

Thanks a lot!

We will get in touch with you as soon as possible.