Kenya 9-22 August 2001

United Nations Millenium Declaration

The special need of Africa

Implementing the Culture of Peace: the health

Application Form

Please return to (by 24^th June):

phone: ++352-+21.744973

fax: ++352-467121

e-mail: Luxembourg@irff-europe.org

Name: ………………………………………………………………………………………………………………

Last First Middle

Date of Birth: ………………………………… Sex: ………

Address: ……………………………………………………………………………………………………………

………………………………………………………………………………………………………………………

Country: ……………………………………….……… E-mail: ……………………………………………… …

Phone: ……………………………………………… Fax: ……………………………………………………

Organisation (you belong to or represent) ……………………………………………………………………..

Primary language: ………………………………………… Other language(s): ………………………..…..

Person to contact in an emergency: ……………………… Phone: …………………………………………

I have read the invitation and I do understand that this project is based on volunteer effort and that I am participating based on this agreement, and that IRFF will not cover any expenses concerning medical care or other personal need.

Applicant's signature: …………………………………… Date / Place: ………………….……………

Parent's signature: ……………………………………… (For those under 18 years of age.)

Any donations to support the project are welcome.