LifeCore Application Form
Your name
*
First Name
Last Name
Name, you want to be called on the training
*
Gender
*
Please Select
Female
Male
Other
Date of birth
*
-
Day
-
Month
Year
Date
Citizenship
*
Phone number
*
Please enter a valid phone number.
Your Email
*
example@example.com
How is your current health condition? Describe your health problem, if there is any, and its current status (physical and psychological state). Name the exact medicine you currently take or had taken in the past 6 months.
*
Have you participated on Basic Synergy/Changemaker/Event Wise/Életműhely program?
*
Please Select
Yes
No
If yes, on which training you took part?(If there are more training you also assisted, list them.)
If you participated on any other kind of personal development program before, please give its name and a short description about it (what it was about, what you got out of it). We might contact you for more details.
*
The reasons why you want to participate on LifeCore program are...:
*
Results, you commit yourself to create in the next one year:
*
Where did you hear about the program?
*
Data Subject Consent (click here for more info)The Data Subject (provider of the data) gives consents for the following purposes of data management:
*
For the purposes of the project administration and implementation
To get information about programs of Egyesek
To receive information about future possibilities (e.g. job vacancies)
To register to the database of Egyesek's newsletter and to receive newsletter from Egyesek
I confirm that...
*
I have read properly the description of the program. (If you haven't, please, do so before you submit this application.)
I am able to cover the contribution of 450 €.
I am able to participate at the whole program. (No early departures/late arrivals are allowed.)
Submit
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