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Echad Participants Submission Form 4 - 9 November 2019
Dear Participant, as first step, I kindly ask you to fill the following form useful to collect the information for planning the mobility and know something about you!
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* Indicates required question
Email
*
Your email
Country of application
*
Your answer
Full Name
*
Your answer
Full Surname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Place of Birth
*
Your answer
Nationality
*
Your answer
Home address
*
Your answer
City
*
Your answer
Identity document
*
Identity Card
Passport
Required
Number of ID/Passport indicated in the previous cell
*
Your answer
Date of expiration of the document indicated in the previous cell
*
MM
/
DD
/
YYYY
Closest Airport (Creativi108 will consider this suggestion, but reserves the right to change the airport of arrival/departure if internal management issues requires this change)
*
Your answer
Personal data treatment
I consent to the processing of my personal data pursuant to Article 13 of Regulation (EU) 2016/679
Clear selection
Intolerances / Allergies
Your answer
Diet
Vegan
Vegetarian
Celiac
Other:
Clear selection
Job
Student
Social Worker
Researcher
Other:
Clear selection
Please, let us know something more about your Job!
Your answer
Explain us why you decided to take part to the Echad project
Your answer
Are you interested in leading a group of participants in the second phase of the project in March 2020?
Your answer
Send me a copy of my responses.
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