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Change Makers' Project Registration Form
Thank you for your interest to serve with CyberCare.

This is the registration form for the CyberCare Change Makers' Project 2018, to be carried out over four consecutive Saturdays - October 20 & 27, November 3 & 10 - from 9am - 2.30pm. The venue of the training will be at Centre Stage, Petaling Jaya. We appreciate you taking the time to share your details and look forward to meeting with you in person.

Surname (as per IC/Passport) *
Your answer
First name (as per IC/Passport) *
Your answer
Age *
Your answer
Gender *
IC No. (for Malaysian) / Passport No. (for non-Malaysian) *
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Person's Mobile Number *
Your answer
Meal Preference (light refreshments will be provided) *
Allergies / Medical Concerns *
Your answer
Expertise (you may select more than one) *
Required
Training Dates (we strongly recommended that you attend all sessions for a productive learning experience) *
Required
How many hours will you be able to commit to serve the underprivileged youth (classes will typically run on weekdays) - Please note this excludes prep work *
Would you be available to support the facilitation of a 3D2N Camp for the Youth (requires overnight commitment) first week of January 2019 *
Do you have any training experience? If yes, please provide brief description on the certificate/courses/exposure ie "attended HRDF TTT", "worked in HR training department for 2 years". If no, please indicate "no" *
Your answer
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