CCCL

Umsiyat application

Name :    

Country :    

City :    

Permanent address :  


Tel :    

Fax :    

Occupation :    

Are you member in an Association ?   Yes       No

What is the name of this association ?    

Contact information

Phone number :    

Email :    

Mobile :    

What type of activities you suggest ? (Musical performances, book signings, round tables, art exhibits, movie screenings...)  


How do you think the activity you suggest relate to cross cultural learning ?  


Indicate the language of the activities suggested :