Better Training for Safer Food - EU countries
Training Courses on Exotic Zoo Animals
TRAINING APPLICATION FORM
Please carefully fill-in this application form before sending it to your National Contact Point (within
your competent authority).
Please note that the designated National Contact Points are responsible for the participant selection.
Selected participants will receive a confirmation letter containing all relevant information on the
training session they will attend.
Seminar
Date
Languages
Location
1
29May-1June ‘12
ENG
2
11-14 September ’12
ENG
3
15-18 January ’13
ENG
4
28-31 May ’13
ENG - FRENCH
5
17-20 September ’13
ENG
Selected
Animal Health of Bees
Prague/Dol
Exotic Zoo Animals
Antwerp
Exotic Zoo Animals
Antwerp
Animal Health of Bees
Prague/Dol
Animal Health of Bees
Prague/Dol
Full Family Name (exactly as indicated on your passport)1:
Full First Name (exactly as indicated on your passport)1:
Date of birth:
Nationality:
Sex:
Female
Male
Language skills:
Fluent
Intermediate
Basic
English
Dietary requirements:
1
Normal diet
Gluten-free
Kasher
Vegetarian
Halal
Other:
As they will be indicated on your flight ticket and on the name tag you will bear during the seminar
None
Contact details:
Address 1:
Address 2:
Zip Code:
City:
Country:
Phone (including international country calling code):
Mobile (including international country calling code)
Fax (including international country calling code):
Email:
Passport data:
Number:
Place and date of issue:
Expiry date:
Educational background:
Doctor in veterinary medicine (DVM)
Engineer
Graduated in microbiology / biology / chemistry
PhD
Lawyer
Other:
Present position:
For which institution are you working?
How long have you been working for this institution?
What is your current position within your institution?
How long have you held this position?
What are your current responsibilities?
If you are working in an Institution, are you working at the Central
level
Specific region/district:
or at the Regional/Local
If you work at the Central level, are you involved in legislation matters?
Yes
No
Are you directly linked to a zoo and part of a zoo management team?
Yes
No
Professional experience:
Brief description of your career:
Could you please, provide us with a study case that you will share with other participants during the
workshops (no more than one or two lines):
Are there particular subjects or specific questions you would like to be addressed during the training?
No
Yes
If yes, please, give details of the subjects or specific questions you would like to be addressed:
Have you already participated to other “Better Training for Safer Food” training sessions in the past?
No
Yes, specify:
Do you have any travel preferences (if applicable):
Flight
Train
Please specify the nearest INTERNATIONAL AIRPORT / RAILWAY STATION for departure:
Your application will be subject to approval by the Executive Agency for Health and
Consumers. Non-attendance or cancellations will be reported to the Agency.
PART FOR THE NATIONAL CONTACT POINT:
Approved by National Contact Point:
Title (Dr/Mr/Mrs/Miss/Ms).......... First Name ......................................................
Last/Family Name........................................................
Job Title .......................................................................
Address.................................................................................................................
Country..................................................................Zip Code ...................................
Tel: ....................................................Fax:............................................................
e-mail: .................................................................................................................