8/16/2019 Wonderland 2016 - Application Form Eng

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Azərbaycan Skautlar Assosiasiyası

Association of Scouts of Azerbaijan

APPLICATION FORInternational Camp

P!RSONAL INFO

Name Surname (As in Passport):Date of birth: Passport n.: Sex:

Address:

 Telephone: Mobile: !mail:

"a#eboo$: S$%pe:

S"ILLS

Spea$in& lan&ua&es: A'erbaiani n&lish Tur$ish "ren#h ussian *ther+++++++++++++++++++ 

*ther s$ills:

!#!RS$IP IN NATIONAL SCO%T OR&ANI'ATION

ole and experien#e in s#outin&,: Date of membership in NS*:

Parti#ipation in international e-ents (if an%):

 our expe#tation from the #amp:

Partici(ant STAFF )arri*es a +eek before t,e ca-(.

Please sele#t preferred role as a STA"" member (Dinin& / #leanin&0 #amp buildin&0 dail% pro&ramme reali'ation0Medi#al0 Sports Instru#tor (mountaineerin&1 alpinism1 pioneerin&1 ar#her%1 shootin& et#)0 Se#urit%0 Suppl%0 Camp&ames or&ani'in&1 other. Mar$ the 2elds belo3 as prefer #onse4uentl%.

/0 10 20 30 450 60

!7ICAL R!8%IR!!NTS

Medi#al #onditions:

Please spe#if% if %ou ha-e an% dietar% re4uirements:

Name and Surname of the person to be #onta#ted in the #ase of emere&en#%:

Phone number of the person to be #onta#ted in the #ase of emere&en#%:

$O! $OSPITALIT9 

Do %ou re4uire 5ome 5ospitalit%: es No

If %es1 please 3rite the dates Arri-al: Departure:

SI&NAT%R!S

Si&nature of appli#ant: Date:

Si&nature of the International Commissioner of NS*: Date:

:ISA

Please enter the information below in the case you need an entry visa to the Republic of Azerbaijan.

Pasport 6: :isas +ill be (ro*i;e; at t,e air(ort

Date of issue of the passport:

Date of expir% of the passport: Date of arri-al to A'erbaian:

Passport issuin& authorit%: Date of departure from A'erbaian:

Please send the flled orm to wonderland2016@scout.az until 6 June2016

A'7rba%#an S$autlar Assosiasi%as8 Mehdi 59se%n $97si ;?1 A@ >Ba$81 A'7rba%#an espubli$as8 Infos#out.a' 333.s#out.a'

mailto:wonderland2016@scout.az%20%20%20%20mailto:wonderland2016@scout.az%20%20%20%20