ECLIPSE WITH AIESEC

APPLICATION FORM

1. Full name_________________________________________________________________

2. Sex_______________________________________________________________________

3. Your city, country________________________________________________________

4. Your e-mail_______________________________________________________________

5. Your LC___________________________________________________________________

8. LC address (e-mail)_______________________________________________________

6. Are you a vegetarian?_____________________________________________________

7.What about drinking?.. _______NEVER_______SOMETIMES _______HEAVY

8. Smoking:___________________YES _____________NO __________SOMETIMES

9. Why do you want to take part in ECLIPSE99 ? _______________________________________________________________________________

Please eMail it at [email protected]
Note that you'll have to pay a part of the fee (25$) before coming here. The account number is 47.51.7.16.0.516.0 opened at BCR (Romanian Comercial Bank) Romania, Mangalia Agency. That's how you can be sure that you will join our project and that you are REALLY going to spend a great hollyday.
Note:As soon as you have payed, write us, so we can check it up and put your name in the delegates list.