Brussels Office: ICA - Avenue Milcamps 105 - 1030 Brussels - Belgium - Tel: +32 2 743 10 30 - Fax: +32 2 743 10 39

Global Office: 150 Route de Ferney - C.P. 2100 - 1211 Geneva 2 - Switzerland - Tel:+41 (22)929 88 38 - Fax:+41 (22)798 41 22
ica@ica.coop - www.ica.coop - www.capetown2013.coop


BURSARY
APPLICATION FORM

Please complete and return this form to Ms Antonina Guarrella: guarrella@ica.coop

Applications must be submitted prior to the deadline: 1 August 2013
Please type or write clearly in black ink.

APPLICANT CONTACT DETAILS

Name
Organisation
Address


Country
Telephone Fax
E-mail

APPLICANT CATEGORIES
Please mark with an x all that are applicable. For other, please specify.

Category
Interest in co-operatives Student
Journalist
Staff in a co-operative
Member of a co-operative
University professor or researcher
Other
Sectors (if representing a
co-operative)
Agriculture/Forestry
Banking/Credit Unions
Consumer/Retail
Fisheries
Health
Housing
Insurance
Social
Other











Brussels Office: ICA - Avenue Milcamps 105 - 1030 Brussels - Belgium - Tel: +32 2 743 10 30 - Fax: +32 2 743 10 39
Global Office: 150 Route de Ferney - C.P. 2100 - 1211 Geneva 2 - Switzerland Tel:+41 (22)929 88 38 - Fax:+41 (22)798 41 22
ica@ica.coop - www.ica.coop - www.capetown2013.coop

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VOLUNTEER

In exchange for bursary funds, each applicant will be requested to work one day
during the conference. Please let us know which tasks you would be interested in
assisting us with. Please mark with an x those tasks you are interested in assisting
with.

Task
Report on one of the sessions (write an article and a social media
message)

Interpreter for participant networking
Coat Check (please tell us when you could do this so that we do not
assign you at the same time as a session you wish to attend)

Usher (please tell us when you could do this so that we do not assign
you at the same time as a session you wish to attend)

Registration Desk (please tell us when you could do this so that we do
not assign you at the same time as a session you wish to attend)

Turn presentations into .pdf and upload to website

Please submit additional information in support of your application stating your
reasons for wanting to attend the conference.




















Applications will be considered by the Committee soon after the relevant closing
date and all applicants will be informed of the committees decisions by email as
soon as possible.

I understand that a bursary will only be awarded if I agree to volunteer to work one
day during the conference. I also agree to attend the conference and if I am unable
to do so, I will return the bursary fees in full to the ICA.

Signature of Applicant:
Date: