Payment of Participation Fee

Institute for Peace and Dialogue, IPD

International Summer Academy on Peacebuilding & Intercultural Dialogue

September 2013, Vienna, Austria

Personal Details

Name:

Surname:

Nationality:

Date of birth:

Place of Birth:

Passport Number:

Date of issues:

Date of expire:

Place of issues:

Your full address:

E-mail:

Cell number:

Skype, MSN, Facebook and etc.:

Relevant Embassy for contacts:

Name of your Organization:

Contacts of your Organization (Full address, email, web page, tel & fax):

Embassy mail, e-mail and fax address which we must send copy of the invitation letter:

Higher Education

Attendance/participation at the relevant training, seminars and etc.

Professional Experience

Language skills

Please outline your motivation, intention and interest for attending in the International Summer Academy. (Not more than 500 words)

Please write “Peace” in your own language: _______________

Declaration of the Applicant:

By submitting this Application Form I confirm that all the information given in this form is correct and complete. I also confirm that I agree to the following conditions of participation:

w I am motivated, willing and available to engage in peace education, civilian peace-keeping and peace-building activities abroad;

w I will not arrive late or depart early;

w I understand that the training institution reserves the right to exclude the participant from the course in case information given in the form proves to be incorrect or because of misconduct at the training site.

Signiture: _____________ Date: _______________

Names, addresses and telephone numbers of two persons whom we may contact as personal references and in emergency situations.

1.

2.

Special needs

Do you have any special needs or requirements that the organizers should take into account during the summer academy (e.g. dietary, disability, etc.)? Yes No If Yes Please specify

Visa

Do you need visa for travel Austria? Yes No

NOTE: Please note that the expiry date of your passport should not be less than six months after the Summer Academy.

Please attach to the filled application: CV & Passport Page (Only photo page)

Deadline: Deadline for submission of application via email and payment of Participation Fee: 25 May, 2013. Only selected candidates will informed about next steps and received additional materials of IPD Summer Academy.

Payment of Participation Fee