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PIU+
Youth Exchange
April 2022 - Paris, France
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* Indicates required question
Name
*
Your answer
Surname
*
Your answer
Nationality
*
Your answer
In which city do you live?
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Age
*
Your answer
Place of Birth (Town, Country)
*
Your answer
Gender
*
Male
Female
Other
How many doses of Covid-19 vaccine have you received?
*
I'm not vaccinated
1
2
3
Other:
phone number
*
Your answer
Complete home address
Your answer
email
*
Your answer
Please indicate all relevant information concerning your health or any special needs or requirements (allergies, intolerances, mobility, medical needs, allergies, dietary restrictions, smoker/non-smoker, etc …) *
*
Your answer
Please indicate all relevant information concerning any special needs or requirements about food (vegetarian, vegan, etc.)
*
YES
NO
Vegetarian
Vegan
Gluten Free
Lactoses intolerance
No Pork
Other
YES
NO
Vegetarian
Vegan
Gluten Free
Lactoses intolerance
No Pork
Other
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