X Congreso Nacional y IV Internacional Aprendizaje Servicio Universitario (U10)

PERSONAL DATA

Please fill in the personal information requested below:

Surname*

Name*

Email*

Contact telephone*

Country*

UNIVERSITY OR ENTITY

Please fill in the data corresponding your profile: university members are requested to indicate the information regarding their Faculty, Department, etc; staff from local public administrations, please provide your department or area, and staff from Third Sector Organizations please provide the scope of action of your institution.

University or Entity*

Faculty

Qualification

Department or Area of Action (last one only for Third Sector Organizations)

SOCIAL PROGRAMME AND ACTIVITIES

Please indicate your interest in participating in the following activities:

Would you like to participate in the activity Sitycleta? (Subject to bicycle availability)* Yes No

Will you attend lunch on June 4th?* Yes No

Will you attend dinner on June 4th? (additional payment of 25€)* Yes No

Will you attend the excursion on June 5th?* Yes No

ESPECIAL CONDITIONS AND ACCESSIBILITY

Please indicate if you require special conditions related to diet or accessibility:

Do you require a special diet?* Yes No

If so, please indicate which:

Do you need specific support needs:* Yes No

If so, please indicate which:

REMARK

Once you send this form, your Registration form will be completed. Remember that the following step is to make your Registration payment. Your Registration will not be completed until you have finished this second step. For further information: Menu Participation>Registration.

Registration form

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