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

 

                        

        The Camp of the Living Stones  

                   27 December-1st January

           Aveiro, Portugal

 

                                                    APPLICATION FORM

                      

                 Closing date for applications: 1st November 2005

           Please send it  to :

         João Vilarinho
      Rua São Francisco Xavier, 130
     3830-617 Gafanha da Nazaré,
     PORTUGAL
     Tel. +351 964 163 653
     Email : jfvilarinho@netvisao.pt
 

 

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 >>>>
  
                                                

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