Full name *
Age *
Gender Female Male
Nationality
Current Address
Phone (with prefix)
Fax (with prefix)
E-Mail Address *
Do you have any special needs on food, other than vegetarian (vegan/alergy)?
Are you planning to bring a child/children with you to Ecotopia?
Physical requirements: Do you need any kind of assistance (people with physical disabilities)? Please specify
You need to bring a tent. Do you have one? * Yes Yes, and I have room for a guest No
Will you attend the whole time? * Yes No
If you checked No above, which dates will you attend?
Do you need a visa for Slovakia? * Yes No
Please only fill out the next fields if you checked Yes above. Visa Information (opens in new window)
Visa: Place of birth
Visa: Date of birth
Visa: Passport number
Visa: Passport date of issue
Visa: Passport date of expiry
Visa: Fax number
Visa: Would you like to apply for visa cost reimbursement? Yes No
Do you need travel reimbursement? * Yes No
If you checked Yes above, please give an estimation of the cost of your return ticket by the cheapest means of export, and how much you want us to pay (we usually don't reimburse more than 70% of the cheapest travel and we don't reimburse flight tickets, see travel reimbursement )
Estimation of travel costs (see text above)
Language: Do you speak English, Russian? *
Which organisations/projects/actions/campaigns are/were you involved in? (if any, it's not necessary to be part of one to attend). If there are web-links, please include them. *
Why do you want to participate in Ecotopia and what do you hope to achieve by going to this meeting? *
Do you want to facilitate a workshop/lecture/training? Yes No
If you checked Yes above, please fill in the workshop form (opens in new window).
Do you want to join the preparation camp a week before Ecotopia to build up the space? Yes No
If you checkd Yes above, when could you come? Do you have any specific skills to offer?
How did you know about Ecotopia? Are you connected to EYFA somehow?
Anything else, you want to tell us?
Any comments on how to improve this online application form?
*) Fields marked with a star are mandatory and need to be filled out.