Conférence Internationale Catholique du Guidisme - International Catholic Conference of Guiding - Conferencia Internacional Católica del Guidismo

 

                         The Camp of the Living Stones

                  26-30 December 2004 - Trento, Italy

 

                            APPLICATION FORM

Closing date for applications: 1st November 2004

Please send it by post to

Mélanie STAHL
 Camp des Pierres Vivantes
  25 E rue du Maréchal Joffre
59120 LOOS
 FRANCE

Tel. 0033 6 86 65 32 90

Email : m.stahl@laposte.net

 

Association

 

Address of association

 

Telephone (including international code):

 

Fax

 

E-mail

 

 

List of participants

 

 (Places are limited: we guarantee three places per association. Associations who wish to apply for more than 3 participants may do so; extra places will be allocated in order to ensure an equal mix of nationalities and sexes).

PARTICIPANT 1
 

Surname

 

First Name

 

Home Address

 

Telephone (including international code):

 

Mobile Telephone (including international code):

 

Fax

 

E-mail

 

Date and place of birth:

 

Sex:  

         M            F

Function within Association

 

Special requirements

(dietary needs, reduced mobility, etc)

 

Language spoken:  

         English            French

Other (please specify) __________________

 

PARTICIPANT 2
 

Surname

 

First Name

 

Home Address

 

Telephone (including international code):

 

Mobile Telephone (including international code):

 

Fax

 

E-mail

 

Date and place of birth:

 

Sex:  

         M            F

Function within Association

 

Special requirements

(dietary needs, reduced mobility, etc)

 

Language spoken:  

         English            French

Other (please specify) __________________

 

PARTICIPANT 3
 

Surname

 

First Name

 

Home Address

 

Telephone (including international code):

 

Mobile Telephone (including international code):

 

Fax

 

E-mail

 

Date and place of birth:

 

Sex:  

         M            F

Function within Association

 

Special requirements

(dietary needs, reduced mobility, etc)

 

Language spoken:  

         English            French

Other (please specify) __________________

 

DATE : ________________________

 

STAMP AND AUTHORISING SIGNATURE OF ASSOCIATION:

 

                                                             NOTE: For the document in Word click here >>>>

                                                              Section   Regions                Accueil  Europe

                                            Accueil français                Home- english                 Acogida-español