Registration Form

Contact details

Title:  Ms. Mr. Other

Surname:

First name:

Name of organisation:

Position in the organisation:

Address of organisation:

Post code:

City:

Country:

Telephone:

Fax:

Email:

Any dietary requirements?

Any other needs/access arrangements?

I will attend on:
 Wednesday 26 June 2013 Thursday 27 June 2013

I would like to participate in workshop:
 Workshop A - Learning Skills and Citizenship Workshop B - Active Engagement and Citizenship Workshop C - Human Rights and Social Solidarity Workshop D - Volunteering and Citizenship

As a second choice I would like to participate in workshop:
 Workshop A - Learning Skills and Citizenship Workshop B - Active Engagement and Citizenship Workshop C - Human Rights and Social Solidarity Workshop D - Volunteering and Citizenship

Disclosure Agreements

Do you agree to appear in the YOURopa video clip that is filmed during the conference?
 Yes No

Do you agree to your photos being taken throughout the conference?
 Yes No

Do you agree that your contact details will be published in the conference material?
 Yes No