APPLICATION

Create your future now

SUSTAINOFUTURELAND
July 22rd 30th 2015
Slovakia
Demnovsk dolina - Hotel Junior Jasn
Please send your application from with the attachment via email to
karin.grobarcikova@rmzk.sk
till 10th April
Personal Details
NAME
SURNAME
DATE OF BIRTH
GENDER
ENGLISH
PROFICIENCY
MOBILE PHONE
E-MAIL
ADDRESS
CITIZENSHIP
T-SHIRT SIZE
(S,M,L,XL)
PASSPORT / ID CARD
DETAILS

Nationalit
y
Number
Place
Issued
Date

Issued
Expiry
Date

Please shortly answer following questions:

1 What is your motivation to participate in Create your future now Sustainofutureland? Do you have any expectations towards the
seminar?

2 Please describe your work or voluntary experience in the field of

youth and youth policy. What is the most successful project you
personally organized or participated?

3 In which way would you like to use knowledge gained in this

seminar?
/Be as specific as possible/

4 Is there anything else what would you like to add or notice?

Special Needs, Emergencies, Conditions

Special needs or requirements:
Please let us know if you require any special arrangements or if there are
things we need to be aware of /for example religious, vegetarian, allergies,
impediments, etc./

Please indicate us the name and full contact details of a person to

be contacted in case of emergency during the seminar:
Name
Phone
[with full international dial codes]
Email
Please take note of the following condition that will apply after you submit
this application:
I commit myself to take part in full duration of the seminar in case of my
selection.

Agreement with personal data processing and with

publishing projects results
In accordance with Act No 482/2002 on personal data protection and
Regulation (EC) No 45/2001 of the European Parliament and of the Council
on the protection of individuals with regard to the processing of personal
data by the European Union institutions and bodies and on the free
movement of such data
I agree with processing and enshrining of my given personal data
by the Regional Youth Council of ilina for purposes of
participants data evidence concerning this project.
YES (please tick one box)

NO

These data will be processed solely in connection with the implementation

and evaluation of the Programme, without prejudice to the possibility of
transferring such data to the bodies responsible for inspection and audit in
accordance with European Union and Slovak Republic legislation especially
with Regulation (EC) No 45/2001 of the European Parliament and of the
Council on the protection of individuals with regard to the processing of

personal data by the European Union institutions and bodies and on the
free movement of such data.
The agreement with your personal data processing is given for an
undetermined time and can be canceled at any time by sending a written
letter to the address: Rada mldee ilinskho kraja (Regional Youth
Council of ilina), Rajeck 17, 010 01 ilina, SLOVAKIA

Contact
We look forward to your early reply. For inquiries and additional information,
please contact
Karin Grobarkov
karin.grobarcikova@rmzk.sk