POB 31417 Jerusalem 91313 Israel http://www.alternativenews.org email: aicmail@alt-info.org
Building 111 Main Street, Beit Sahour
Queen Shlomzion Street 4, Jerusalem
Tel 972-2-2775444 Fax 972-2-2775445
Tel 972-2-6241159 Fax 972-2-6253151
9th International Political Field Seminar - Bridges Instead of Walls!
26th – 31st July– The Alternative Information Center
APPLICATION FORM
Deadline: 15th July 2011
NOTE: Please fill in the form in English
Family Name:
First name:
Gender:
Personal address :
E-mail :
Telephone:
Date of Birth :
Nationality :
Level of English:
Job Position or University faculty:
Why you are interested in participating in the seminar?
POB 31417 Jerusalem 91313 Israel http://www.alternativenews.org email: aicmail@alt-info.org
Building 111 Main Street, Beit Sahour
Queen Shlomzion Street 4, Jerusalem
Tel 972-2-2775444 Fax 972-2-2775445
Tel 972-2-6241159 Fax 972-2-6253151
What is your current knowledge of the Israeli-Palestinian conflict, Palestinian society and
Israeli society?
Are you currently active in any political, solidarity and/or social justice groups? If so,what?
How did you hear about the seminar?
Special dietary requirements (vegetarian, ciliac, other):
Allergies, other health concerns that may affect your participation :
Your personal data will be used for our purposes only and will not be distributed.
Date:
Signature of Applicant:
Please send this form to:
aic.camps@gmail.com