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Application for the FreedomBus

2015 - Cross-cultural Dialogue for
Freedom and Peace tour
Stage 1:
1st throug 18th September 2015
From Krakow/Poland to the cultural capital 2015, Mons/Belgium

P l e a s e f i l l i n t h e f o r m i n c a p i t a l l e t t e r s a n d s e n d s i g n e d t o a d r e s s b e l o w. We w i l l o n l y a c c e p t f u l l y c o m p l e t e d a n d
readable forms.

Personal Data:
Name, Surname
Nationality

Date and place of birth

I represent the country

Private address (street, ZIP, city, country)

Phone no. (country code, area code, number), e-mail
Bank account data for refunds:
Name of bank:
Location of Bank:

BIC:

IBAN:

Institution/university, faculty, semester

Contact person at the institution (title, surname, name, e-mail address)
Student

private (Artist, scientist etc.)

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My project focus/my area of work

1. Artistic workshops:
Design

Art

Architecture

Installation

Video

Sound

Photography

Sculpture

Urban Art

Industrial

Performance

Sociology

misc.

Visual Art (drawings etc.)

Paper

Metal
misc.

2. Scientific workshops:
History

History of Art

Motivation letter
For the artistic workshop, please include 2 to 3 pictures of your art work.
If room is insufficient, please continue on an additional page.

Food preferences, allergies or food intolerances

No

Yes, type:

Vegetarian or other:

With my signature I bindingly register for my participation in the first stage of the FreedomBus 2015 - Crosscultural Dialog for Freedom and Peace tour taking place from 1st to 18th September 2015. Tour members must
arrive in Krakow, Poland on 31st August 2015.
I have filled out the form correctly and truthfully.
I have read, understood and accepted the terms and conditions.

Place, date and signature of applicant

Due to semester break, please send to private post address of the organisor:

Prof. Anna Bulanda-Pantalacci

Januarius-Zick Strae 67
54296 Trier, Germany

and as scanned copy to on of

the following emaildresses:

www.cross-border-network.eu

info@cross-border-network.eu
a.bulanda@cross-border-network.eu
j.buerger@cross-border-network.eu

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Participation conditions
Enrollment & Participants fees
The enrollment in the project FreedomBus - Intercultural Dialogue for Freedom and Peace Stage 1 is binding
after the application form has been filled out correctly and the participation fee of 120 has been paid in full on
or before 30th June 2015.
All bank service charges and transfer fees must be carried by the Participant.
No part of the fee of 120 will be reimbursed if after 7th July 2015 the application is withdrawn or if the Participant does not appear at the location of the project. However, the would-be Participant may then appoint a
substitute.
In case of illness or other important reasons that are not in the responsibility of the applicant part of the fee may
be refunded at the Organizers discretion.
The Organizer reserves the right to reject applications if more than the planned number of applications is received. Applications are processed in sequence of their arrival (Date of stamp).
Board and lodging / travelling expenses
The Organizer of the Cross-Border Network project bears the travelling, board and lodging cost of the FreedomBus and will provide the materials.
Upon presentation of the original flight/train/bus tickets the Organizer will pay each Participant a travel allowance of up to 110 for the travel to Krakow on 31th August 2015 and departure from Mons on 18th September
2015. The allowance will not be paid if the Participant arrives late or leaves the project prematurely.
Damages liability
The Organizer of the project FreedomBus - Intercultural Dialogue for Freedom and Peace will not be responsible for any damage caused by the Participant. The Participant is liable for all damages caused by him.
Termination of the contract between the Participant and the Organizer of the project
If a Participant strongly interferes or acts contrary to the contract conditions albeit dissuasion of the Organizer
the contract may immediately be void. The Organizer reserves the right in this case to retain the complete enrollment fee of 120.
Health insurance
By signing the contract the Participant confirms to be in possession of valid health insurance coverage for travel
abroad (see attached page).
The Participant is advised to contact their health insurance company to ensure sufficient coverage before embarking on the FreedomBus 2015 tour.
Usually the statutory health insurances do not cover private accidents and illness such as appendicitis during foreign excursions and normally do not provide ambulance transport home. Therefore, a private health insurance
with return transport is recommended.

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Privacy policy
The Participants accepts that the Organizer electronically processes and stores their data for registration, settlement and correspondence. This data will not be foreclosed to any third party except for visa matters.
The Participant pledges to immediately inform the Organizer about any changes in their personal data, especially
changes of the address and email address.
It is in the Participants responsibility to be in possession of a legitimate visa/stay permit for Germany, Poland,
Belgium and Luxemburg. The Organizer assumes that the Participant is in possession of all valid visas and stay
permits.
The Participant agrees that the Organizer may send them emails.
The Participant agrees that all photos and videos taken during the journey of FreedomBus - Intercultural Dialogue for Freedom and Peace on which they may be seen are published and used for public relations, print and
Internet for introduction of the project in public.
Intellectual property rights
By accepting the agreement conditions the Participant also agrees that all work and open publications developed during the project may be used for promotion and advertising of and by the Cross-Border Network and
the participating institutions. The work results remains property of the Cross-Border Network until the end of
2016. The work will be displayed within the scope of various exhibitions in different locations.
At the end of 2016 all works of art may be returned only at the authors expense. The Organizer will not carry
any costs for that.
Miscellaneous
Certificate and credit points
After completing stage 1 of the project FreedomBus - Intercultural Dialogue for Freedom and Peace Participants are issued a Certificate of Participation. It contains information about the time duration, workload and
work performed.
The amount of credit points (ECTS) is determined in correspondence with the examination regulations of the
individual home-university and are credited after presentation of a project documentation and the Certificate of
Participation. For example at the UoAS Trier in the course Communication Design the project is recognised as
external projects module and credited with 5 ECTS.
Termination of the agreement for extraordinary reasons
The Organizer as well as the Participant can retreat from the agreement if the project is significantly impeded,
endangered or impaired by acts of God, war, riots, natural disasters or epidemics. In this case the full enrollment
fee of 120 is immediately reimbursed to the Participant. The Participant has no further claim.

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Declaration:
I hereby declare in lieu of oath that I am in property of a health insurance valid for the
countries of travel and for the time period of the FreedomBus 2015 tour from 31th
August through 18th September. The Organizer of FreedomBus - Intercultural Dialogue
for Freedom and Peace will not be held liable for any injury or accident during the entire
event.
Please fill in form legibly in capital let ters, sign and deliver to the given contac t address.

Name, Surname
Name of health insurance company

Place, Date and signatur of applicant

www.cross-border-network.eu