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:
Company name:
Company Address:
VAT Number:
HUMAN RIGHTS VILLAGE
Monastery of San Nicol | Riviera San Nicol 26 30126 Venezia Lido (Italy)
Tel: +39 041 2720911 | Fax: +39 041 2720914 | Email: info@eiuc.org | Web site: www.eiuc.org

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 VILLAGE

Monastery of San Nicol | Riviera San Nicol 26 30126 Venezia Lido (Italy)
Tel: +39 041 2720911 | Fax: +39 041 2720914 | Email: info@eiuc.org | Web site: www.eiuc.org