application venice school

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Application Venice School 2015 Title: Mr./Ms Name: Surname: Gender: Nationality: Date of Birth: Place of Birth: Visa needed: Yes/No Accommodation needed: Yes/No Dietary Requirements: None/vegetarian/vegan Special dietary/medical needs: Actual Position: E-mail: Permanent Address for invoice purposes: Phone: Mobile: Cluster: Motivation: Payment will be made by: me personally/my employer Fiscal Code/Personal Identification Number: VAT: If payment is made by your employer, please specify the following information: HUMAN RIGHTS VILLAGE Monastery of San Nicolò | Riviera San Nicolò 26 30126 Venezia – Lido (Italy) Tel: +39 041 2720911 | Fax: +39 041 2720914 | Email: [email protected] | Web site: www.eiuc.org

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Application Venice School 2015

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Application Venice School 2015

Title: Mr./MsName:Surname:Gender: Nationality: Date of Birth: Place of Birth: Visa needed: Yes/NoAccommodation needed: Yes/NoDietary Requirements: None/vegetarian/veganSpecial dietary/medical needs: Actual Position: E-mail: Permanent Address for invoice purposes:Phone: Mobile: Cluster:Motivation: Payment will be made by: me personally/my employerFiscal Code/Personal Identification Number: VAT: If payment is made by your employer, please specify the following information:Company name: Company Address: VAT Number:Companys Fiscal Code (if applicable):Privacy (Do you accept EIUC Privacy Policy Information Brief for Visitors as described at http://www.eiuc.org/privacy-policy.html?): Yes/No

HUMAN RIGHTS VILLAGEMonastery of San Nicol | Riviera San Nicol 26 30126 Venezia Lido (Italy)Tel: +39 041 2720911 | Fax: +39 041 2720914 | Email: [email protected] | Web site: www.eiuc.org