Work camps

Application form for Participation in International Multi-Disciplinary Work camps
Mandatory fields are marked with *

Family name *

Given names *

Sex Male Female *

Date of Birth (dd.mm.yyyy)

Nationality *

Present occupation *

Area of Specialisation *

if student, state subject area

Address (2000 chars left) *

Postal Code *

City *

Country *

Telephone

Mobile Phone

Work phone

Email *

Emergency contact (phone number) / name of the contact person whilst you are away on the project

Passport number (Check visa requirements for chosen project location) *

Give details of your voluntary / community work experience including work camps if applicable (2000 chars left) *

Reason(s) for participation in workcamp (2000 chars left) *

What do you think you can contribute to the workcamp as a volunteer? * (2000 chars left) *

Mother tongue *

Other languages you speak. Please indicate Fluent, Good, or Basic.

Special Dietary needs, e.g. vegetarian, Religious, Medical reasons

Any serious accidents, illnesses, disabilities, allergies

Western Africa II : A. Bumbuna town and 15-20 villages in Northern Sierra Leone. B. Gelehun, Blama and 12-15 towns and villages, 170 km from capital city Freetown along Bo/Kenema highway including chiefdom sections of Fallay, Kamboma, Sowa, Nyama and Gorama. 19th October - 2nd November, 2018 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Western Africa III: Bamenda Cameroon in Collaboration with Ministry of Health Cameroon, AEMRN Bamenda Cameroon Period: 10th April - 17th April 2019 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Western Africa I: Nigeria - Cross River State including the surrounding villages of Akpabuyo, Akamkpa and Odukpani Period: 31st May - 9th June, 2018 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Southern Africa I - Lusaka, Zambia Lukulu and 15-20 surrounding towns and villages 45 to 600 km from capital city Lusaka, Zambia Period: 23rd June – 30th June 2020 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Western Africa IV Ghana Prampram and 15-20 surrounding villages about 50-70 Km from Accra the capital of Ghana - Period: 29th July - 7th August, 2019 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

East Africa II Uganda – Outskirts of Kampala and surrounding towns and villages Period: 13th July - 20th July 2019 Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Eastern Africa - I: Kenya - Kitale, Matisi, Kisumu, Bungoma, Mateka, Kaptanai and 20-25 surrounding villages North Western Kenya. Period: 23rd August - 2nd September, 2018. Choose Choose 1 Choose 2 Choose 3 Choose 4 Choose 5 Choose 6 Choose 7

Estimated time you can afford to volunteer at the Workcamps *

Why do you choose this particular workcamp? (2000 chars left)

What do you expect from it? (2000 chars left) *

If necessary, please indicate the dates within which this address is valid. (2000 chars left)

Thanks a lot!

We will get in touch with you as soon as possible.