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EDUCATE – CONNECT – INSPIRE YOUTH FORUMS ON CLIMATE CHANGE 2011 / 2012 PARTICIPANTS FORM Please fill in and email to environment@nektarinanonprofit.com Yes, I would like to participate in ECI Youth Forum on Climate Change Last name

____________________________________________

First Name

____________________________________________

Contact Email

____________________________________________

Country

____________________________________________

Town

____________________________________________

Age

____________________________________________ Please proceed to page 2

ECI Youth Forums on Climate Change 2011/ 2012 www.nektarinanonprofit.com Page 1


Would you be able to follow the forum in English language: □ Yes

□ No

□ I might need a translation for certain topics

If you are a pupil / student, please state the name of your school / college, and your class ____________________________________________________________________ ____________________________________________________________________

Please tell us what is your favourite subject in school? ________________________________________________

Please tell us what are your interests / hobbies? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

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Please proceed to page 3

Please tell us if you use social networks: □ Facebook

□Twitter

□ both Facebook and Twitter

□ another social network (please state which one) ________________________ _________________________________________________________________

Date

____________________________________

Thank you for filling the form! You will be informed about available dates and venue for ECI Youth Forum in your country.

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For first hand updates join our Facebook page www.facebook.com/1010teen Or follow us on twitter www.twitter.com/1010hub

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Profile for Nektarina Non Profit

ECI Youth Forum participants form  

ECI Youth Forum participants form

ECI Youth Forum participants form  

ECI Youth Forum participants form