Multidisciplinary Training Programme - Czechia

First name (in Latin Alphabet) *

Please indicate your name as indicated in your passport

Last name (in Latin Alphabet) *

Please indicate your last name as indicated in your passport

City of residence *

Email *

Please confirm by entering your Email address twice.

Confirm the previous field *

Mobile Phone *

Gender Identity *

Please select your professional profile: *

Years of Experience *

Institution/Organisation *

Official Job Title *

Please give your official Job Title

Did you already participate in the EU-PROMENS Exchange Programme? *

I agree to the terms regarding programme costs, cancellations, and the accuracy of personal information provided. *

I commit to attend the full training programme *

I confirm my willingness to train others in the organisation post-training *

How do you prefer to travel to the destination? *

All modes of transport will be booked by you and reimbursed after completion of the Training Programme.

Other *

I need accommodation

Please be informed that accommodation will be provided only in case it is not possible to travel to the location daily.

Other *

I have read and understood the terms and conditions for reimbursement of travel and meal expenses. *

Do you have any medical conditions or pathologies that we should be aware of? If yes, please provide details.

Please also provide details on arrangements that should be made by our side.

Do you have any dietary restrictions or special requirements? *

Other *

Please specify your allergies: *

Do you need any special arrangements due to disabilities or special needs? Please specify.

Full Name *

Email Address *

Confirm the previous field *

Phone Number *

Relationship *

Do you need an official invitation letter for your organization to authorize the mission?

Name of Organisation *

Name of Superior (if needed) *

Street *

Zip Code *

City, Country *

Bank Account Holder (Name) *

Name of Bank *

IBAN *

Street & Number *

Zip Code *

City *

Country *

I have understood that, if I don't fill in the modification page within 1 week after being selected, my seat will be given to someone who is on the waiting list. *

How did you hear about this course?

Other *

I have read and understood the Consent for Data Protection Notice on the Training Programme. *

Consent to the use of data*

List of participants: I hereby agree that my personal data – name and surname: professional profile, organisation, email and mobile – will be named and published in the list of participants of the programme.

I hereby agree to be part of pictures taken during the visit for reporting and communication purposes. *

I understood *