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EREMO TRAINING Psychological Consequences of
Organized Violence and Terror: Application form |
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| Turn
Back |
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|
EREMO TRAINING Psychological Consequences of
Organized Violence and Terror: Application form |
|
| Name (underline family name): | __________________________________________________ |
| Gender: | __________________________________________________ |
| Nationality: | __________________________________________________ |
| Date of birth: | __________________________________________________ |
| Mailing address: | __________________________________________________ |
| Telephone: | __________________________________________________ |
| Fax: | __________________________________________________ |
| Email: | __________________________________________________ |
| Profession/Education: | __________________________________________________ |
| Present position: | __________________________________________________ |
| Psychotrauma courses attended: | __________________________________________________ |
| __________________________________________________ | |
| Work experience related to psychotrauma: | __________________________________________________ |
| __________________________________________________ |
Please write a small paragraph referring to the following questions:
Why do you think psychotraumatology knowledge/proficiency is important for your work/life?
Why do you wish to attend this course (please indicate the practical use of the course for your work/personal life; please also specify individual development needs and learning interests)?
Do you have a medical history or emotional difficulties that we should know about? (confidentiality will of course be ensured).
Return it to:
vivo
Flurweg
3
78464
Konstanz, Germany
Tel:
+49-(0)172-635 7359
elisabeth.schauer@vivo.net;
<www.vivo.net>
Bank:
Sparkasse
Konstanz, Germany, Account No 85985, Bank Code 6905000; Swift Code: BIC: SOLA DE
S1 KNZ
or
Banca
delle Marche, Italy; Branch No 325, Account No 4000; Abi No 6055; Cab No 21325;
Swift BAMAIT3A301
Upon
application please make sure to complete the following Application Form
and return it before July 15, 2002 together with a EURO 100, - deposit
(EU check or bank transfer, subject: ‘eremo
Training 2002’ application fee + your name) to the above address.
