Registration Form

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11th European Deafblind Holidays

Hotel Sopron****
Sopron, Hungary, from 4 to 11 August 2008
Hosted by Hungarian Deafblind Association

I Declare That I Am Interested To Take Part In The 11th European Deafblind Holiday In Hungary.

Family name:
First name:
Gender: male/female (delete as appropriate)

Organisation:

I am (delete as appropriate):

1. Deafblind participant
2. Interpreter-guide / assistant / family member to deafblind participant named: .
3. Floating interpreter-guide / visiting professional

My Contact Details

E-mail:
Telephone and/or Fax:
Home address
Street:
Postal code:
City:
Country:

Special Dietary Needs

I don't eat and/or drink as follows:

I request Vegetarian meals (delete as appropriate):
YES/NO

I need a special diet as follows: .

Special Requests

I read (delete as appropriate):

1. Braille
2. large print
3. normal print

I use (delete as appropriate):

1. Sign language
2. Lorm
3. Malossi
4. Spoken language
5. Written language
6. other:

I am a wheelchair user (delete as appropriate):
YES/NO

I will bring a guide dog with me (delete as appropriate):
YES/NO

Other requests:

List Of Participants

The List of participants will be given to the participants of the holiday as well to organizers of future holidays but will not be made available for commercial purposes.

I agree to a publication of my contact details in the List of participants (delete as appropriate):
YES/NO

Date:
Signature of the person intending to attend the holiday:

(If Registration Form is completed by E-mail, signature will not be required)

(2007-11-22)