Pre-registration Form

A - Institution

Name

Address City/Town

Post Code Country

Phone Fax e-mail

Partner Associated Partner Participant Non Member

B - Teacher

First Name Last Name

Phone Mobile Phone e-mail

Gender Particular needs

C - Students

Student n. 1

First Name Last Name

Gender Age Particular needs

Student n. 2

First Name Last Name

Gender Age Particular needs

Student n. 3

First Name Last Name

Gender Age Particular needs

Student n. 4

First Name Last Name

Gender Age Particular needs

D - Comments

Enter your comments in the space provided below:

To submit by not later than February 28th, 2009