Registration Form, Health and Tourism 2021

1

Email

example@example.com

2

NameOfficial name as indicated on your ID

First Name

Last Name

3

Date of Birth

Date

4

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

Gender

Male

Female

Rather not say

6

OccupationWhat do you do for a living?

7

InstitutionWhich institution do you work with or study at?

8

Is this your first time participating in Health and Tourism?

YESNO

10

If you chose other, please indicate where.

11

What is your motivation for joining us?Why do you want to go on this adventure with us?

12

What do you seek to achieve at the end of the project?Have you any set targets?

13

Do you have any known medical condition?

YESNO

14

If yes, what is it and do you think it will affect your participation?

15

Do you have any dietary exemptions?

YESNO

16

If yes, what are they?

17

Who do we contact in case of an emergency?

18

What is your relationship with the person?

19

Emergency Contact Number