ࡱ> ]2bjbjx-\x-\#$8D|v $H9 " 0l"l"l" ^l" l"l"fpp#x!V!csDF0vs|!#x#xx l" ! v R L:FORMULARZ ZGAOSZENIOWY W CYKLU SZKOLENIOWYM W RAMACH PROJEKTU  LABORATORIUM FILMOWE Imi i nazwiskoAdres zamieszkania (w tym gmina i wojewdztwo)Telefon kontaktowykom.e-mailNazwa i adres instytucji/organizacji, w ktrej jest Pani/Pan zatrudniony (lub wykonuje czynno[ci w oparciu o umow wolontaryjn)Funkcja w instytucji/ organizacjiLokalizacja Instytucji/organizacji: % miejscowo[ poni|ej 20 tys. mieszkaDcw % miejscowo[ 20  60 tys. mieszkaDcw % miejscowo[ 61  120 tys. mieszkaDcw % miejscowo[ powy|ej 120 tys. mieszkaDcwProsz oceni poziom swojej wiedzy na temat edukacji filmowej: U|ywajc skali 1  5, gdzie  1 oznacza ocen bardzo nisk, a  5 bardzo wysok, prosz oceni swoj obecn wiedz 1 2 3 4 5  Dlaczego chce Pani/Pan wzi udziaB w cyklu szkoleniowym? (maksymalnie 5 linijek)  Jakie s Pana/Pani oczekiwania wobec szkoleD? Jakiej wiedzy i umiejtno[ci szczeglnie Pani/Pan poszukuje? 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U. nr 133 poz. 883. Administratorem danych jest Fundacja Rozwoju Kina. % TAK % NIE O[wiadczam, |e wszystkie podane dane s zgodne z aktualnym stanem prawnym i faktycznym. & & & & & & & & & & & & & & & & & & & & . podpis uczestnika Prosimy o wypeBnienie zaBczonego formularza i odesBanie go poczt lub mailem w terminie do 22 wrze[nia 2014 na adres biura Fundacji Rozwoju Kina (ul. Pychowicka 7, 30-364 Krakw) lub drog elektroniczn na adres z.popik@frk.org.pl. 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