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Participation Form
Training Course "Breaking Points"
12.09.2022 - 20.09.2022
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have subscribed Instagram*
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have subscribed Youtube*
First Name (as in your PASSPORT)
Gender
*
Male
Female
Last Name (as in your PASSPORT)
Birthday
Citizenship
Email
ID Number
Birth city
Country of residence
Phone (with international code +...)
Whatsapp number (with international code +...)
Emergency contact (name, relationship, phone number with country code)
When do you plan to arrive to Paola TRAIN STATION?
When do you plan to departure from Paola?
What time do you plan to arrive to Paola TRAIN STATION??
What time do you plan to departure from Paola?
Please specify if you have any special needs (vegetarian, vegan, health issue etc.)
Have you been vaccinated against COVID-19?
*
Yes
No
With which vaccine are you vaccinated?
Have you recovered from COVID-19?
*
Yes
No
Do you have EU Digital COVID Certificate?
*
Yes
No
How many shots of vaccine have you received?
Select your sending organisation
*
Romania - Club Faci-Sport
Spain - Asociación PROJUVEN
North Macedonia - Center for Culture, Communication and Education of Roma "Svetla idnina - Bright Future" Kocani
Italy - Associazione Minerva
Bulgaria - Alternativi International
Germany - Copernicus Berlin e.V.
Please add any additional comments if any
I hereby confirm that I am a resident of the country I represent
I agree that during this training course pictures and/or videos of the participants will be taken and published on the homepage (https://www.copernicusberlin.de/), in (print) publications, on the Facebook-, Twitter-, Instagram-, Youtube-, LinkedIn-pages of COPERNICUS BERLIN and may be saved for this purpose*
I have read and accept the terms and conditions stated in the
participant declaration*
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