Registration form for the Central European LEO Workshop 2002 
Budapest, 15–17 March 2002

Name:… ……..…………….      		First name:….……………...

Address:……………………...…………………………………………..

ZIP Code : …….…..   Country: …………………   Date of birth:……………...

City: ….………………………...	     Phone: +…………………..……………

Mobile Phone:  +……………………...     E-mail…………………….…………...

LEO (Multiple ) District: ….…….     	     Leo Club: ……………………………...

Official position:  ……………………..    Other: ………………………………..  

Wants to share room with: ……………..……………………………………..…

Arriving with:          Car,	 Plane,	       Train  	or other: …………………

License plate: ……………….	Flight Nr.: ……………	Train Nr.: …………..

Arrival Date…………..……………  	Arrival Time…………….………….….

Departure Date……………….		Departure Time…..……………

Things we should know about yourself  (vegetarian, health problems, allergies, doctor, etc.): 

…………………………………………………………………………………………………...

Emergency address (please indicate us whom we should inform in case of emergency)

Name : ……………………… .			First Name :  .…………………
Relation : … ……………………..			Phone : +………………….

Signature : ..………………………

After fiilling out the application form, please send it back to the following addresses:

KOVÁCS, Gergely	H-1148 Budapest, Bolgárkertész utca 13/E, Hungary
			ganf79@axelero.hu

WEIGL, Mátyás	H-1086 Budapest, Dobozi utca 49-53, 1/I, Hungary
			weigl.matyas@interware.hu or weiglmatyas@hotmail.com