Application form

Name
Address
Date of birth (must be no earlier than 13 June 1986)
Telephone
Email address
The five successful candidates will receive a confirmation letter and additional important details about this weekend.
How would you prefer to receive this information? o Email or o Post
What I would hope to gain from going to this event
Please use this space to let us know why you are interested in coming to the Activism Gathering and what you would do with the skills, knowledge, and contacts you made over the course of the weekend. Feel free to continue overleaf
What I would hope to gain from going to this event (cont.)

Please return, with payment to: Friends of the Earth, 7 Donegall Street Place, Belfast, BT1 2FN.

For extra copies of this booking form please contact or phone 028 9023 3488