Please answer EVERY question using the boxes below.

1. I am aplying to register me as participant for the International Summer Camp (18th-27th of July, 2008):

PERSONAL DATA
2. Participant´s Fullname

3. Date of birth

4. Sex Male Female

5. Nationality

6. Full postal address:

St. Postcode Country Telephone

CONTACT INFORMATION IN CASE OF EMERGENCY

7. Name and address of person who may act on my behalf if I cannot be contacted: (You must answer this question)

St. Postcode Country Telephone

PHISICAL AND MENTAL HEALTH

8. Our acceptance is on the understanding that you are in good physical and mental health and is able to function independently in a multinational community.

Please disclose here any past/present health problems, allergies or behavioural factors of which we should be aware before acceptance:

9. Character, favourite activities and sports and/or other information that may help us:

10. Can you swim? Yes No

TRAVEL
11. I will Get to and leave from destination by my own Request ICC make the travel arrangements (only if avalaible)

PAYMENT OF SURF CAMP FEES

12. If this application is accepted, when I receive your Invoice, I shall

SEND FULL PAYMENT OF SUMMER CAMP FEES IN EUROS € IMMEDIATELY

SEND 50% OF THE SUMMER CAMP FEES IN EUROS € IMMEDIATELY AND THE OTHER 50% IN EUROS € BY 15TH OF MAY 2008

13. I agree with the rules of the Surf Camp as set out in the brochure.

14. I understand that if for any reason not covered by our Insurance policy a participant withdrawn from the Surf Camp less than 30 days before it begins, or fails to attend the Surf Camp, or leaves before it ends, no refund of Fees will be given unless a suitable replacement participant accepts the place.

15. I understand that if any Fees remain unpaid fifty days after the date of the Invoice (unless otherwise stated on the Invoice), and if any Fees remain unpaid fifty days before a Surf Camp begins, acceptance of the participant will be withdrawn and the place will be considered to have been cancelled.

16. I understand that Insurance is only as described on the Insurance 2008 information sheet. I accept the terms and agree to be bound by the conditions of the Insurance cover. I declare that I am in good mental and physical health.

17. If neither the undersigned nor the person in question 7 can be reached in an emergency, I consent to medical treatment being authorised by Verónica Mayado of ICC|Instituto del Comportamiento.

18. I understand that Spanish and PorgueseLaw applies to all aspect of International Summer Camp.

PLEASE DO NOT MAKE THE PAYMENT FOR THE INTERNATIONAL SURF CAMP FEES UNTIL YOU RECEIVE OUR INVOICE

Office address:
International Summer Camp ICC|Instituto del Comportamiento
C/ San Vicente Ferrer, 7, 1º1
E-37008. Salamanca. Spain
International Telephone: +34 923 213901

Bank Address

ACCOUNT NUMBER: 0182 2309 43 0201530928
IBAN: ES19 0182 2309 4302 0153 0928
BIC/SWIFT: BBVAESMMXXX

We will confirm by letter the details given. We suggest you print this form for your records before you press 'submit'.