Tilmelding * Enrolment * Inscription * DURBAN REGION

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Voluntary assistant in Durban Region
	Please fill out in English and press the SUBMIT button at the bottom of this page. For voluntary social work enrolments send a mail to info@exis.org with your CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.
Date:
First name:
Last name:
Full address:
Country:
Telephone:
E-mail:
Nationality:
Passport number:
Education:
Birth date:

Special qualifications:

How long have you studied English?	years months

Work experience:

Do you smoke?	yes
	no


Are you under any medical treatment, if yes, please specify!

Are you vegetarian or vegan?	yes
	no

Expected arrival date:

Duration voluntary work:	I would like to follow 1 week preparation activities and outings and would like to give voluntary assistance for a duration of:
	2 weeks
	3 weeks
	4 weeks
	5 weeks
	6 weeks
	7 weeks
	8 weeks
	9 weeks
	10 weeks
	11 weeks
	12 weeks


Travel together?	Do you wish to travel together with other volunteers if possible?
	yes
	no

	If you want to travel with a friend, please state his/her name:



Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

How did you find Exis? Where did you hear about EXIS?


		Remember to mail the following document : Letter of motivation, stating why you would like to volunteer and if you have any relevant experience or personal interests.