Name *

Surname*

Middle Name

Sex *

House Name/Number *

Post Code *

City *

Country

Phone *

Date of Birth *

Email address *

Who to contact in case of emergency? *

Phone*

Driving experience (years)

English

Other language

Passport no. *

Valid until *

Diet requierements?

Medication? (if yes please state)

I’d like to join the Romania event (30 July - 13 August 2012 - participation costs £800).
I’d like to go to the following outreach destination

No preference

I’d like to join the Albania event  (21 July - 4 August participation costs £850).

I’d like to go to the following outreach destination

Macedonia

Albania

No preference

I’d like to join the Asia event(2 - 12 October 2012 - participation costs £1300).

Romania conference (30 July - 3 August) - participation costs £300

Albania conference  (21 - 26 July) - participation costs £300

I am an active member of the following church

Name of your Pastor/Vicar

Telephone

Email address

I agree with the terms and conditions as stated. I accept the general group rules as given by the leaders at the conference and at the outreaches. I participate at the programmes at the conference and will use my talents and gifts during the outreach.

Driving license:

* Mandatory fields

Iaşi

Babadag

Experience driving a minibus?

International driving experience?

I speak the following languages:

I just want to join in for the conference:

Reference:

Slobozia

I’d like to join the Belgium event (25-31 August 2012 - participation costs £300).

Kosovo

I’d like to join the Israel event(26 February - 8 March 2012 - participation costs £995).

Adress*