/ Visa Detail Form
Network Meeting
for Guide and Scout Representatives

to National Youth Councils and the European Youth Platforms

13-16 February 2014

Zagreb, Croatia

Please complete this form in CAPITAL lettersand return it by 14th January 2014to the WOSM-European Regional Office, Avenue de la Porte de Hal 38,

1060, Brussels, Belgium

e-mail:

Family name and First name:______

Place and date of birth:______

Gender: Male  Female

Passport no.: ______Nationality: ______

Place of issue:______Date of issue:______

Contact address: ______

______

Telephone (with prefixes): ______

Fax: ______

E-mail: ______

Organisation: ______

Position in the Organisation: ______

Please indicate the category that best describes your spoken English and/or French. Please be aware that if you indicate that you can manage in a language there may not be any interpretation/translation available for you.

English  Very good  Good  Can Manage  Poor  None

French  Very good Good Can Manage  Poor  None

What other languages do you speak (incl. mother tongue)?

______

Do you have any dietary or other special requirement? Please specify

______

Do you need an official invitation to obtain a visa?  Yes No

If so please complete the attached visa request form and send it by 15th December 2013.

______

Declaration by the International Commissioner:

I confirm that the applicant meets all criteria in the paragraph “profile of participants” written in the invitation.

Date and (Digital) Signature of International Commissioner: ______

If you need an official letter of invitation in order to apply for a visa, please complete this form in CAPITAL lettersand return it by 15th December 2013 together with your application form to the WOSM-European Regional Office, Avenue de la Porte de Hal, 38, 1060, Brussels, Belgium

e-mail:

Family name:______

Name:______

Date of birth:______

Place of birth:______

Nationality:______

Passport N°:______

Date and place of issue:______

Expiry date:______

Full Address (as indicated on passport):
______

Private Telephone No. ______Private Fax No.______

E-Mail address: ______

Requested duration for the Visa. From ______to ______

Fax number of the Croatian Embassy/Consulate in country of residence and person to contact.

Fax No.______Name of Contact: ______

Date:______