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EIRENE Youth Exchange 2
06th - 13th November 2022 (8 days+ 2 travel days)
05st November: arrival day - 14th November: departure day
Italy, Casa Laboratorio il Cerquosino - Orvieto (TR)
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SENDING ORGANIZATION
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FIRST NAME (complete legal name):
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FAMILY NAME:
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GENDER:
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DATE OF BIRTH:
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PLACE OF BIRTH (town, country):
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RESIDENCE ADDRESS (road, number, zip code, town, country):
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EMAIL:
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EMERGENCY CONTACT (first name, family name, phone number):
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SPECIAL NEEDS AND HEALTH REMARKS:
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DIETARY NEEDS: (intolerances, restrictions, allergies) please specify
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PLEASE INDICATE THE DATE SHOWN OF THE CERTIFICATE, RELATED TO THE DOSE OF VACCINE OR THE RECOVERY FROM COVID-19:
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CITY OF DEPARTURE Please, specify the city, and the nearest airport, from where you will start your travel to join the project:
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CITY OF RETURN (only if different from the city of departure) Please, specify the city, and the nearest airport, where you will return after the project:
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