Friends of the John Adams Society Registration Form

Username*

First Name*

Last Name*

Exchange programme*

Exchange title*
the title of your programme ie “Young European Leaders” or “Climate Change & Renewable Energy”

Exchange year*

Occupation

Current Job Title*

Organisation*

Address 1*

Telephone

Alternative address
work, parents, etc

Alternative Telephone

Mobile

E-mail*

Alternative email

Brief biography

Areas of particular interest

Password*
Type your password. Minimum length of 6 charactersStrength indicator

Repeat Password*
Type your password again.

Notes
add any other useful information

Prove you’re human*

Send these credentials via email.