1. REGISTRATION FORM FOR
TWO WEEKS TRAINING PROGRAM
IN BARKA’S NETWORK IN POLAND
5th – 17th of August
th
Please complete and return by e-mail to the address maria.sadowska@barka.org.pl by 27 of July.
1. Participants information
Family name:________________________________________________________________
Title:_______  Prof.  Dr.  other:_________________________ Mr.  Ms.  Mrs.
First name:__________________________________________________________________
Telephone:__________________________________________________________________
Fax:_____________________________ E-mail:_____________________________________
2. Information about the organization/institution you work for
Organization/institution name: __________________________________________________
Address: ___________________________________________________________________
City: _______________________________________________________________________
Country: ___________________________________________________________________
What does your organization/institution do? _______________________________________
___________________________________________________________________________
___________________________________________________________________________
3. Please write in a few sentences why you would like to participate in this
training programme in Barka Poland (Why do you think it could be important to you
and your work? What do you hope to gain from it?)
___________________________________________________________________________
___________________________________________________________________________
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2. 4. Dietary Requirements
Special dietary requirements:
I am non-vegetarian/vegetarian/other (please specify): _____________________________
___________________________________________________________________________
5. Additional Information
Payment Information: The training program is free of charge. It is fully financed by the
Leonardo da Vinci Mobility 2012 Program from which Barka IE received a grant.
Comment on Participants: An individual can only profit once from a Leonardo funding in a
PLM (people in the labour market) target group.
The participant must be:
- a national of a country participating in the Lifelong Learning Program;
- a national of another country, who is enrolled in regular courses in schools or
institutions of Vocational Training in a participating country, or employed or living in
participating country.
Europass Mobility: Europass Mobility will be awarded to all participants.
Deadline: Please return completed registration form by 6th of July by e-mail to the address
maria.sadowska@barka.org.pl. Please use one form per person. If you should have any
problems registering or any other questions, please contact Maria Sadowska
(maria.sadowska@barka.org.pl or phone +48 530 435 179).
Confirmation: Please allow 3 days for e-mailed confirmation of your registration.
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