Young Water Action Team

PART I: MEMBERSHIP APPLICATION

First Name *

Last Name *

Nationality *

Gender *

Date of Birth * 19

Postal address

Zip code

City

Country *

Email address *

Telephone number

Fax number (if applicable)

PART II: MY ACTUAL OR PROPOSED ACTIVITIES

Please write down any proposals/ideas you have as part of a YWAT activity. What are you going to organize? Or what kind of activity are you already involved in? Include the main goals, objective(s), target group, time schedule (if applicable). Please describe your plans/initiatives as detailed as possible.

PART III: EDUCATIONAL BACKGROUND

Current occupation (profession of study) * :

(max: 60 digits)

Language skills:

Language	Spoken	Reading	Writing

Academic level (degree, diploma) including subject, where and what level achieved.

Time	Place	Subject	Qualification

Work experience (especially water-related activities and including voluntary unpaid work).

Time	Place	Job Title	Responsibility

I hereby declare that to the best of my knowledge and belief the foregoing statements are true. I also undertake to notify YWAT in case of any change to the information given above.