Surname:.............................................................................................................................................

First name:..........................................................................................................................................

Date of birth........./.........../............ Age:............................ Sex:............................................................

Address: .............................................................................................................................................

Zip code: ........................................ City: ......................................... Country: ..................................

Nationality: .........................................................................................................................................

Phone number: ....................................................................................................................................

Fax number: ........................................................................................................................................

E-mails: ................................................................................................................................................

Name of the university or college: ........................................................................................................

Major subject: .......................................................................................................................................

Specialisation in: ..................................................................................................................................

Year of study: ......................................................................................................................................

Please write your level of skill by marking the appropriate language with:

ML = mother language F = fluent G = good M = moderate

Language Reading Writing Spoken

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Name of the Organisation: ........................................................................................................................

Address: .................................................................................................................................................

Zip code: ........................................ City: ......................................... Country: .....................................

Phone number: ......................................................................................................................................

Fax number: .........................................................................................................................................

E-mail: .................................................................................................................................................

Internet: http:// .....................................................................................................................................

Position and Responsibility in your organisation: .............................................................................….

Informations about your organisation: .............................................................................…..................

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