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AV Application Form - - Africa and Asia Venture

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Application form

Application Form

If you’re ready to join us on a volunteering adventure in Africa, Asia or the Americas on our 3-5 month Gap Ventures, 3 or 5 week Short Ventures, please apply below…..

Mandatory fields are marked *

Name in full *

Gender

Date of Birth: *

Nationality (as on passport)*

Religion (if applicable)

Home Address 1 *

Home Address 2

Home Address 3

Town/City *

County/State *

Postcode/Zip Code *

Country *

Telephone *

Mobile *

Email *

VOIP Name (e.g. Skype)

Are you... *

School/University/Employer *

Address 1 *

Address 2

Town/City *

County/State*

Post/ZIP code

Country *

Telephone

Date of Leaving *

Select Project

Which project?*
(E.g. Teaching, Environment etc)

Which first choice country?*

Which second choice country?*

When can you go?*
Check our departure dates

Why would you like to join the AV Scheme?*

How did you hear about AV? *

Which One?

Further Info

Most Recent Academic Qualifications

Degree course

List your hobbies & interests (including sports) *

I CONSENT TO AV OFFICES, IN UK AND ABROAD, AND MY PROJECT HOSTS HOLDING MY PERSONAL DATA.

PLEASE TICK TO CONFIRM THE INFORMATION YOU HAVE PROVIDED IS CORRECT AND YOU HAVE READ THE TERMS & CONDITIONS.

Which country?*

When can you go?*
Check our departure dates

Group Coordinator (if booking with a group)

How did you hear about AV? *

Which one?

Further Info

Emergency Contact (e.g. Mother, Father etc)

Title *

Forename *

Surname *

Relationship *

Address *

Post/Zip Code *

Country *

Telephone *

Cell/Mobile *

Email *

Alternative Emergency Contact (e.g. Mother, Father etc)

Title:

Forename:

Surname:

Relationship:

Telephone:

Cell/Mobile:

Email:

Passport Details (as they appear on your valid passport)

Name in full:

Date of Birth (DD/MM/YY):

Passport Number:

Date of Issue (DD/MM/YY):

Date of Expiry (DD/MM/YY):

Issuing Authority (e.g. UKPA):

Nationality:

Health Details

Any Dietary Requirements? *

State of Health: *

Can you swim *

Do you have any allergies to drugs, foods, immunisations? *

Are you under Medical Treatment or taking any medication? *

Have you suffered from Epilepsy, fits, blackouts, diabetes, an eating disorder, nervous and / or mental illness or Asthma in the last 5 years? If so, which? *

Do you have any other medical condition of which we should be aware? If so, what? *

Do you have a criminal record? *

Please provide any additional information that may affect your participation in your project: *

We ask for these details to help us make your project successful.
Please note all information provided in this form is confidential.

A non-refundable registration fee of GBP£200 is due with this application form.

If you would like to pay by cheque, please send to Africa & Asia Venture, 10 Market Place, Devizes, Wiltshire, SN10 1HT.
If you choose to pay by Credit/Debit card or by online bank transfer we will contact you to confirm payment details

Please select payment type*

I CONSENT TO AV OFFICES, IN UK AND ABROAD, AND MY PROJECT HOSTS HOLDING MY PERSONAL DATA.

PLEASE TICK TO CONFIRM THE INFORMATION YOU HAVE PROVIDED IS CORRECT AND YOU HAVE READ THE TERMS & CONDITIONS.

Which project? *
(Scuba diving or Windsurfing)

When can you go?*
Check our departure dates

Group Coordinator (if booking with a group)

How did you hear about AV? *

Which One?

Further Info

Emergency Contact (e.g. Mother, Father etc)

Title *

Forename *

Surname *

Relationship *

Address *

Post/Zip Code *

Country *

Telephone *

Cell/Mobile *

Email *

Alternative Emergency Contact (e.g. Mother, Father etc)

Title:

Forename:

Surname:

Relationship:

Telephone:

Cell/Mobile:

Email:

Passport Details (as they appear on your valid passport)

Name in full:

Date of Birth (DD/MM/YY):

Passport Number:

Date of Issue (DD/MM/YY):

Date of Expiry (DD/MM/YY):

Issuing Authority (e.g. UKPA):

Nationality:

Health Details

Any Dietary Requirements? *

State of Health: *

Swimming Skill Level

Do you have any allergies to drugs, foods, immunisations? *

Are you under Medical Treatment or taking any medication? *

Have you suffered from Epilepsy, fits, blackouts, diabetes, an eating disorder, nervous and / or mental illness or Asthma in the last 5 years? If so, which? *

Do you have any other medical condition of which we should be aware? If so, what? *

Do you have a criminal record? *

Please provide any additional information that may affect your participation in your project: *

We ask for these details to help us make your project successful.
Please note all information provided in this form is confidential.

A non-refundable registration fee of GBP£200 is due with this application form.

Please select payment type*

I CONSENT TO AV OFFICES, IN UK AND ABROAD, AND MY PROJECT HOSTS HOLDING MY PERSONAL DATA.

PLEASE TICK TO CONFIRM THE INFORMATION YOU HAVE PROVIDED IS CORRECT AND YOU HAVE READ THE TERMS & CONDITIONS.

When can you go?*
Check our departure dates

How did you hear about AV? *

Which One?

A non-refundable registration fee of GBP£200 is due with this application form.

Please select payment type*

I CONSENT TO AV OFFICES, IN UK AND ABROAD, AND MY PROJECT HOSTS HOLDING MY PERSONAL DATA.

PLEASE TICK TO CONFIRM THE INFORMATION YOU HAVE PROVIDED IS CORRECT AND YOU HAVE READ THE TERMS & CONDITIONS.