Inclusion TV Application Form
 

 

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1. Title

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2. What is your first name?

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3. What is your last name?

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4. How would you describe yourself?

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5. What is your gender?

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6. What is your age?

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7. What is your correspondence address?

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8. Postcode

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9. Telephone

10. Alternative Telephone (mobile)

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11. Email Address

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12. Do you consider yourself to have a disability?

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13. Are you allergic to any medication?

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14. Do you require any additional assistance or special arrangements because of a disability (eg. hearing loops,ramps, visual aids, etc.)?

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15. Do you have any dietary or religious requirements?

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16. Do you suffer from any condition requiring medical treatment or medication

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17. What evenings do you need accomodation?

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18. What is the name of your organisation?

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19. Please describe your organisation's work

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20. What is the address of your organisation?

21. What is your organisation's website?

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22. What is your previous Youth In Action / international project experience?

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23. What experience of inclusion practice do you want to share with others?

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24. Did you attend either of these previous events?

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25. Do you have a short film you wish to show other delegates (5 min max.)

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26. How did you hear about this event?

27. Are there any questions you have for the organising team?

Note: All information will be handled in confidence and in accordance with our privacy and data protection policies.

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