Intersex Youth Network Participant Application Form

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* 1. Personal Details (please remember that only people who are resident in a Council of Europe member state are eligible.)

First Name

Last Name

Date of birth (dd/mm/yyyy)

Age

Country of Residence

Organisation (if relevant)

Mobile Number (include +country code and no spaces between digits)

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* 2. Member Organisation (please remember that priority will be given to individuals who are representing an IGLYO/OII Europe Member Organisation and who have discussed their participation with the organisation's leadership/management.)

I am representing an IGLYO Member Organisation

I am representing an OII Europe Member Organisation

I am representing another organisation

I am applying as an individual

If you represent an organisation, please write the organisation name and contact information (phone/email)

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* 3. Do you require a visa to travel to Belgium? If you do, please answer Q4. If you do not, you can go to Q5)

Yes

No/I already have a valid visa

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* 4. If you require a visa, please fill in the following information and we will send you a letter of invitation:

Full Name (Passport)

Nationality

Date of birth

Gender (as it is in the passport)

Passport Number

Date of issue (DD/MM/YYYY)

Country of issue

City/town of issue

Expiry date (DD/MM/YYYY)

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* 5. Through which source have you learned about this event?

	IGLYO	OII Europe	Other
Website	Website IGLYO	Website OII Europe	Website Other
Email	Email IGLYO	Email OII Europe	Email Other
Facebook	Facebook IGLYO	Facebook OII Europe	Facebook Other
Other social media	Other social media IGLYO	Other social media OII Europe	Other social media Other

If you selected other, please tell us which organisation or source.

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* 6. How well can you understand and speak English?

Fluent

Advanced

Average

Basic

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* 7. Why do you want to participate in this event and what do you expect to learn/achieve by taking part?

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* 8. What do you hope to contribute to this event and the intersex youth movement more generally?

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* 9. Please share with us ideas or suggestions you might have for this event. This will NOT be considered in the selection of participants. We appreciate any input!

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* 10. How many IGLYO events have you applied for before this one?

None

One or more

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* 11. How many IGLYO events have you participated in for before this one?

4 or more

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* 12. Please read here IGLYO's ground rules for educational activities and then tick if you agree to commit to respecting them.

I have read the ground rules and, if selected, commit to respecting them the best I can