Registration form template - Interreg Euro-MED : Green living areas

Contact details

Salutation*

Ms

Mr

Name*

First name Last name

Email*

Location

Country*

If you selected "Other", please specify

Stakeholders identification

What type of stakeholder are you?*

Which project?*

If you selected "Other", please specify:

What area do you work in?*

If you selected "Other", please specify:

What is your area of activity / intervention?*

Organisation*

Type of organisation*

If you selected "Other", please specify :*

Job title

Privacy and validation

I authorize Interreg Euro-MED to use any pictures and/or videos taken at this event in which I appear. The pictures / videos will be published on the Programme website and other social media or publications.*

Yes

No

(If you choose "Yes", these pictures will only be used to illustrate the event itself, or in further dissemination/reporting. Choosing "No" will not prevent you from being accepted as a participant in the event.)

I allow Interreg Euro-MED to share my contact details (name, surname, email, organisation and job title) with the other participants.*

Yes

No

(If you choose "Yes", your contact details will appear on a participant list that might be shared with other participants to help you network and communicate. Choosing "No" will not prevent you from being accepted as a participant in the event.)

Would you agree to be contacted by email or telephone for additional information collection purposes?*

Yes

No

Event

Contact details

Location

Stakeholders identification

Privacy and validation

For more information, feel free to contact us!!!