REGISTRATION FORM Please indicate activity: O – Activity 2 Youth Exchange in Giessen 16.07.-30.07.16 O – Activity 3 Youth Exchange in Sievershausen 15.08. - 28.08.16 Please send by e-mail to [email protected] First name Family name Sex Mail contact Skype Adress Do you need visa invitation? If yes: Nr of Passport Expiry date Phone Emergency contact Country: Date of birth: Birth place: Nationality: Languages spoken, please rate according your ability: MOTIVATION for participating in this training or youth exchange? Would you like to share anything else with us? Previous experiences in youth work? Previous experiences in supporting refugees or peace work? Special needs / Dietary restrictions? TERMS AND CONDITIONS I hereby agree to the following terms and conditions: 1. I will organize and cover my own travel expenses to the venue and back and will submit my travel documents to the organizers. I will pay a fee for placement of about 80,- Euro to this account: ICJA Freiwilligenaustausch weltweit e.V. Bank für Kirche und Diakonie Dortmund BLZ 350 601 90 Konto 1011 8120 11 BIC: GENODED1DKD IBAN: DE 56 3506 0190 1011 8120 11 The organizer (ICJA e.V.) will pay a contribution to my travel expenses according to the funding rules (Erasmus+ Programme) applicable to the youth exchanges in Giessen and Sievershausen (activity 2 &3) as follows: Germany, Belgium, France (100 – 499 km): 80 € France, Greece, Turkey, Hungary, Croatia, Serbia, Italy (500-1999 km): 170 € 2. Payments for travel reimbursement will be done via sending organization The organizer (ICJA e.V.) will cover my food and accommodation in a hostel during the training, in a seminar house in Sievershausen. In case of Giessen there will be shared rooms in a school. I agree to share a room with other participants. (4- or 6-bed rooms, in Giessen even bit more) 3. The organizer (ICJA e.V.) will cover my visa expenses up to the budget limit 60€ 4. Local transport will be covered only for travels related to the program 5. I will actively participate in the preparation, program as well as follow-up activities to spread the project results. Signature of participant Signature of partner organization _________________________________ __________________________________ REGISTRATION AND INFORMATION - please use this contact for registration programme and visa issues : Nikolaus Ell: [email protected] – - please use this contact for emergencies : Andreas Schwab: [email protected] - for your reference : https://www.yapcfd.de/content/Seiten/Young_Activists_for_Peace_refugees_wellcome/ ICJA Freiwilligenaustausch weltweit e.V. Löwengasse 27C 60385 Frankfurt www.icja.de / www.yap-cfd.de Deutschland Phone: +49 (0)69-98 19 19 57 Fax: +49 (0)69-98 19 16 17 skype: ICJA_workcamps
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