APPLICATION FORM FOR SUMMER SCHOOL (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
Accommodation
I would like a single room at a supplement of €100.00 for the week (subject to availability)
I would like to share a room with
I would like to enroll as a day student (no accommodation)
  I would like to stay one extra night (Friday July 24th) at a supplement of € 30.00 35.00 45.00 35.00
  I would like a room with private bathroom at a supplement of € 80.00 160.00 for the week (Please note: all private bathrooms are now allocated. Selecting this will add you to the waiting list).
Dietary Requirements and Special Needs
I would like to take the meat option for meals (mostly meat, some fish and vegetarian)
I would like to take the fish option for meals (mostly fish, some vegetarian)
  Please indicate any other special needs (vegetarian, vegan, gluten free diet, mobility etc.)**
Subsidised Attendance
I would like to apply for a LEATSS scholarship, to attend at the special reduced fee of €350.00
Project Preferences
Course options will be made at the beginning of Summer School. However, we would like to gauge your interest in the student led practical project.
I am interested in directing/leading in the practical project
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.
   
eight plus seven equals? (this is just to check that you really are human)
**We cannot guarantee provision for all special needs, but will do our best