Get Online Week - Registration

Get Online Week 2011 - Application Form / Stakeholders
28 February - 5 March 2011 Dear Stakeholders! We are very pleased that you are willing to take part in Get Online Week. We hope it will be a rewarding experience and would like to ask you to fill in a short application form below. Please note, that all the fields are mandatory, except for COMMENTS. If you have any questions, please contact Laurentiu Bunescu at Laurentiu.Bunescu@telecentre-europe.org. Best regards, Telecentre-Europe team.
STAKEHOLDER INFORMATION


Name


City


Country


E-Mal


Busines Address:


Postal/Zip Code


Telephone (with a country code):


Web:


CONTACT PERSON


Please choose one:
Mr. Mrs. Ms.

First Name


Last (Family) Name:


Title/Position:


Direct e-mail:


Direct Telephone (with a country code):


Thank you for your time! Upon receiving this form we will contact you for involvement details.