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  Pre-registration form  
 
                                                                           
 
 
 PRE-REGISTRATION FORM
     
 
 Jump Over the Wall 
           
 Biography, European Citizenship and Empowerment of Women. Course for Adult Educators on Biographical Method in Empowering Education
     
Cracow, Poland, 24th till 30th March 2013
        
Grundtvig Course, Session 2, Reference Number in EU Grundtvig/Comenius Training Database: PL-2012-108-004
   
First Name  
 
   
Family Name   
 
  
Nationality
 
  
Date of Birth 
 
  
Postal address for correspondence 
 
  
E-Mail address 
 
  
Tel. 
  
English language skills, mark from 1 low to 5 high 
 
Reading:        Speaking:       Writing:
 
 
Other languages
 
  
Education, including gender education or gender activities. 
 
  
Workplace/Occupation
(if applicable). If retired / unemployed: what former job did you do? 
 
   
 
 
 
What is your main motivation to take part in the course? 
 
 
 
 
 
 
Other information you would like to mention 
 
  
    
 
 
Date: ………………………………….
 
  
    Fundacja Kobieca eFKa
  
To pre-register for the course, please complete and send this pre-registration form back to jow@efka.org.pl.
 
If you have any questions, please, contact us via e-mail:   jow@efka.org.pl.  
 
 
 






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