<p> BETTER TRAINING FOR SAFER FOOD Training Course on Animal by-Products</p><p>TRAINING APPLICATION FORM</p><p>Please carefully fill-in this application form before sending it to your National Contact Point (within your competent authority). Please note that the designated National Contact Points are responsible for the participant selection. Selected participants will receive a confirmation letter containing all relevant information on the training session they will attend.</p><p>Training Date Location Selected</p><p>1 14 to 17 May 2013 Maribor, Slovenia</p><p>2 11 to 14 June 2013 Antwerpen, Belgium</p><p>3 02 to 05 July 2013 Specific Event</p><p>4 03 to 06 September 2013 Maribor, Slovenia</p><p>5 15 to 18 October 2013 Antwerpen, Belgium</p><p>6 12 to 15 November 2013 Dusseldorf, Germany</p><p>7 10 to 13 December 2013 Maribor, Slovenia</p><p>8 14 to 17 January 2014 Maribor, Slovenia</p><p>9 11 to 14 February 2014 Antwerpen, Belgium</p><p>10 11 to 14 March 2014 Maribor, Slovenia</p><p>11 24 to 27 June 2014 Antwerpen, Belgium</p><p>12 09 to 12 September 2014 Dusseldorf, Germany</p><p>13 21 to 24 October 2014 Antwerpen, Belgium</p><p>14 11 to 14 November 2014 Antwerpen, Belgium</p><p>15 09 to 12 December 2014 Dusseldorf, Germany 1 Full Family Name (exactly as indicated on your passport) : </p><p>1 Full First Name (exactly as indicated on your passport) : </p><p>Date of birth: </p><p>Nationality: </p><p>Sex: Female Male </p><p>Language skills: Excellent Intermediate Basic None English</p><p>Dietary requirements: Normal diet Gluten-free Kasher</p><p>Vegetarian Halal other: </p><p>Contact details:</p><p>Address: </p><p>City: </p><p>Country: </p><p>Phone (including international country calling code): </p><p>Mobile (including international country calling code): </p><p>Email: </p><p>Identity Document: Passport Identity Card </p><p>Number: </p><p>Place and date of issue: </p><p>Expiry date: </p><p>Educational background: Doctor in veterinary sciences</p><p>1 As they will be indicated on your flight ticket and on the name tag you will bear during the seminar Engineer</p><p>Doctor in Sciences (biology / chemistry / ...)</p><p>Other: </p><p>Present position: For which institution are you working?2</p><p>How long have you been working for this institution?</p><p>What is your current position within your institution?</p><p>How long have you held this position?</p><p>If you are working in an Institution, are you working at the Central level </p><p>Regional/Local level , which region/district: </p><p>Are you responsible for developing animal by-products strategy and policies? No Yes, Please indicate in what areas you develop animal by-products strategy and policies: </p><p>Professional experience: Brief description of your career:</p><p>2 This will be indicated on the name tag you will bear during the seminar Are there particular subjects you would like to be addressed during the training? No</p><p>Yes, which ones: </p><p>Have you already participated in other “Better Training for Safer Food” training sessions in the past? No</p><p>Yes, specify: </p><p>Do you have any travel preferences (if applicable): Flight Train Car</p><p>Please specify the nearest INTERNATIONAL AIRPORT/TRAIN STATION for departure: </p><p>Your application will be subject to approval by the EU Directorate- General for Health and Consumers. Non-attendance or cancellations will be reported to the Directorate.</p><p>PART FOR THE NATIONAL CONTACT POINT:</p><p>Approved by National Contact Point: </p><p>Title (Dr/Mr/Mrs/Miss/Ms)...... First Name ...... </p><p>Last/Family Name...... </p><p>Job Title ...... </p><p>Address...... </p><p>Country...... Zip Code ...... </p><p>Tel: ...... Fax:...... </p>