Scribd
Upload
33 views

Youth Model Asean Conference (Ymac) 2013 Annex B Registration Form Youth Model Asean Conference (Ymac)

This document contains a registration form for the Youth Model ASEAN Conference (YMAC) 2013. The form requests information such as the participant's name, nationality, age, home address, emergency contact details, dietary requirements, medical history, and a declaration agreeing to comply with the conference rules. Participants are asked to provide details of any medical conditions, allergies, or need for routine medication.

Uploaded by

Fikri Ali Nawawi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
33 views

Youth Model Asean Conference (Ymac) 2013 Annex B Registration Form Youth Model Asean Conference (Ymac)

This document contains a registration form for the Youth Model ASEAN Conference (YMAC) 2013. The form requests information such as the participant's name, nationality, age, home address, emergency contact details, dietary requirements, medical history, and a declaration agreeing to comply with the conference rules. Participants are asked to provide details of any medical conditions, allergies, or need for routine medication.

Uploaded by

Fikri Ali Nawawi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

YOUTH MODEL ASEAN CONFERENCE (YMAC) 2013 REGISTRATION FORM YOUTH MODEL ASEAN CONFERENCE (YMAC) 29 Nov 2 De 2013

ANNEX B

All information provided will be kept strictly confidential and use only for YMAC

Name (as in passport and underline surname)

Affix Recent Passport Size Photograph Here $%shirt Size

Nationality Singapore Citizen Singapore PR thers! pls specify " ######################## Race Age

&S &( Religion

S &&(

'

&&&(

Sex )ate of *irth Home Address

NR+C No

Postal Code" Home $el No Handphone ,mail Course"


-ear

+nstitution (eg" Singapore Polytechnic)

-ear

-ear

)ietary Re1uirements

Chinese 'uslim 2egetarian thers! please specify " ################## Relationship

Name of ,mergency Contact

Address (only if the address is different from a3o4e) Contact Payment Home $el Che1ue No" HP *an5" ff $el

'edical )eclaration .) Ha4e you e4er had chest pain high 3lood pressure heart pro3lems asthma 3ronchitis tu3erculosis fits epilepsy fainting attac5s se4ere head in6ury ear pro3lems7deafness ner4ous illness dia3etes a carrier status for any infectious disease medical treatment for a3o4e 8ithin last / years! if yes! please specify ############################ /) )o you re1uire routine medication currently9 No 0) )o you ha4e a: any disa3ilities or chronic medical ailment 8hich may affect your participation for this conference No -es! please specify ############################################ -es! please specify ############################################

3: any other medical information7allergies to note for this conference No -es! please specify ############################################

;) + am currently not suffering from any acute diseases or ailments

Declaration I declare that I am currently not suffering from any acute ailments or diseases. I shall comply fully with the conditions and regulations laid down by the YMAC Organizers 2013. I confirm that I have read and fully understood all the Parts in this registrationformandthat all the informationprovidedhereinis true.

Name of Participant

Signature

Date

You might also like