APPLICATION FORM FOR CopE 2021 (New Student)

Personal Details
 
Name (First / Last ) /
Address
City
Post Code
Country
Email address
Phone number(s) Home Mobile
Date of Birth
Gender
Nationality
Heard about LEATSS from
Dietary and other special requirements
I would like to take the standard option for meals (includes meat, some fish and vegetarian)
I would like a diet with neither fish nor meat
  Please indicate any special needs (vegetarian, vegan, gluten free diet, mobility etc.)*
Data Privacy
  I consent to LEATSS a.s.b.l. storing my personal data electronically according to their privacy policy
  I consent to photographs taken during LEATSS events that contain images of me being stored electronically and used in publicity material.
   
seven plus four equals? (this is just to check that you really are human)
*We cannot guarantee provision for all special needs, but will do our best