Please do not write in this space
Europe of Freedom and Democracy Group in the European Parliament
APPLICATION FORM
(to be completed preferably by electronic way or in CLEAR capital letters using black ink)
1.
SURNAME[1]
FORENAMES
2.
Address:
Telephone numbers:
(All correspondence will be sent to this address.
Home:
Please notify us immediately of any change of address)
Work:
Street:
No:
Post code:
Town:
Country:
e-mail address:
Fax No.:
3.
Place and date of birth:
4.
Sex:
Male
Female
5.
Marital Status:
6.
Present nationality (if dual indicate both):
7.
Knowledge of languages
a) Mother tongue:
b) Other languages:
Danish
Dutch
English
Finnish
French
German
Greek
Italian
Portuguese
Spanish
Swedish
Very good
Good
Fair
ATSEZAR