16 ApplicationForm 2015

Application
Deadline: 6th September 2014

Name:
Heather Marie Durkin

Sex:
Female
Date of Birth:
08/03/98
Age
16
Email: [e-mail] Mobile Number:
07780623853
Home phone number: 01943 884497
Address:
2 Hillway
Guiseley
Leeds
LS20 8HU
Current Branch:
Leeds
Previous
CISV activities
Village (Portugal) - 2009
Interchange ( Sweden) - 2010
IYM (Munich) - 2011
Project GB (14-15) - 2013
Big Sibling on Project Gb - 2014
Current involvement with your local/ national Junior Branch?
I currently attend Leeds Junior Branch most months and I am the elected treasurer for the forthcoming year. I've also attended national juinor branch events such as NJB day and mini- camps.

Please tick the box if you do not want your personal information distributed by email within CISV. We never pass on your personal information to other organizations or third parties.

Please indicate in the table below which programmes you are applying for. If you are applying for more than one, please indicate the order of preference (“1” being your first choice).

Order of preference:
Comments*:
JC 16/17
1

Seminar 17/18
2

YM 16/18

YM 19+

IPP 19+

*If you have any specific preferences, or have any dates you would like to avoid you can add a note here. Please remember that we cannot always match everyone’s requirements as places are limited. Specific destination /dates are not known at the present time and can change.

If you are applying for a YM as well as another programme and would like to attend both (if your application is successful), please note this in the comments section.