This is your registration for the IP2013 Outreach. The prices are as follows: Accommodation and meals take place in the Saracen hotel, which also serves as the conference location, near the city of Palermo. Team Leader // Participant without a Team:Name First Last Email Date of Birth Date Format: MM slash DD slash YYYY Nationality:Gender Male Female PhoneCountry of ResidenceAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweTeam InformationAmount of Team members:MalesFemalesArrival Date Date Format: MM slash DD slash YYYY Arrival Time : HH MM Arrival LocationWe have prepared/will prepare the following program for Evangelism (please describe; you will be contacted by IPTeam for details):DramasDancesMusic (bring your own instruments!):Testimonies:Children’s program:Other:Language Skills & Do you need/have an interpreter?After the IP2013I / Some people from my team are interested about the possibility to continue for a second outreach week in Europe or beyond: Yes/No (If yes, you will be contacted from PEFY Impact Teams). You can look for interesting options here. Yes No I / some people from our team are interested in full-time missionary service and would like to have more information of the PEM Missions Course in Brussels: Yes/No (If yes, you will be contacted by PEM Office) Yes No Person RecommendingName First Last Email PositionPlease also inform IL2012 about your:Our Team commits to work under the leadership of the IL2012 Outreach: Yes . Yes / No Yes No Our Team takes a travelling insurance for all participants coming from outside Luxembourg). IP2013 Is not responsible for the participants. Yes / No (Your registration will not be accepted without a commitment to take a traveler’s insurance). Yes No Team Members:Name M/F Age EmailName :: Gender :: Age :: EmailPlease tick all the nights you need the accommodation: (27.-28.3.) 28.-29.3. 29.-30.3. 30.-31.3. 31.3.-1.4. (1.-2.4.) I take the meals during the conference: Yes No T-shirts:Female t-shirts to our group:Small:Medium:Large:Xtra-Large:Male T-shirts:Small:Medium:Large:Xtra-Large:
