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Visually Impaired Version
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THE FIRST WORLD CONGRESS FOR PERSONS WITH DISABILITIES
MAKING VALUES VISIBLE
RUSSIA - YEKATERINBURG 2017



APPLICATION FORM
The First World Congress for the persons with disability

Name
*
Surname
*
Gender
*

State
*
Town/city/other type of settlement
*
ZIP code (P/O code)
*
Citizenship:
*
Language:
Participant's status:
*

Do I have an accompanying person?:
*

Accompanying person’s details:
*
Forename:
*
Surname:
*
Languages:
Contact details:
*
Email:
*
Tel./Fax:
*
Eating habits:
*
Vegan/vegetarian:
*
Allergy-prone, please, indicate:
*
Special needs (environment/ accommodation):
I am planning to take part in the following events:
Workshops and master-classes in the following areas:
I am willing to take part in the following events:
I need Visa Support:
*

The fee for the Congress:
*





Please note that Application Form will be accepted and registered in due course only against a payment.

Name:
*
Surname:
*
Gender:
*

State:
*
Town/city/other type of settlement:
*
ZIP code (P/O code):
*
Citizenship:
*
Language:
Participant's status:
*

I accompany up to:
*
persons.
Accompanied persons:
*
Forename and Surname:
*
Contact details::
*
Email:
*
Tel./Fax:
*
Eating habits:
*
Vegan/vegetarian:
*
Allergy-prone, please, indicate:
*
Accompanying support:
*

I am planning to take part in the following events:
Workshops and master-classes in the following areas:
I am willing to take part in the following events:
I need Visa Support:
*

The fee for the Congress:
*



Please note that Application Form will be accepted and registered in due course only against a payment.