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Application Form progetto xxxx
30th of April - 06th of May 2024 (5 days of activiy + 2 travel days)
30th of April arrival day , 06th of May 2024 departure day
Somos Garaldea - Madrid Spain
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PLEASE, CONFIRM THAT YOU HAVE READ LUNARIA PRIVACY POLICY (
https://www.lunaria.org/wp-content/uploads/2018/06/privacy_gdpr-1.pdf
) :
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I CONFIRM
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LUNARIA
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Country - Sending organisation
Country - Without sending organisation
FIRST NAME (complete legal name):
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Your answer
FAMILY NAME:
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Your answer
E-MAIL:
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Your answer
TELEPHONE (code+number, e.g. 0039 068841880):
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Your answer
RESIDENCE ADDRESS (road, number, zip code, town, country):
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Your answer
Age
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Your answer
GENDER:
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Male
Female
Other
Required
DATE OF BIRTH:
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MM
/
DD
/
YYYY
PLACE OF BIRTH (town, country):
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Your answer
NATIONALITY:
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Your answer
SPECIAL NEED AND HEALTH REMARKS:
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Your answer
DIETARY NEEDS (intolerances, restrictions, allergies):
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No extra requests
Vegan
Vegetarian
Lactose free
Gluten free
No pork
No fish
No alcohol
Other:
Required
EMERGENCY CONTACT (firt name, family name):
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Your answer
EMERGENCY CONTACT (phone number):
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Your answer
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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Your answer
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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Your answer
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