BLUE Leadership Programme Sign-up
Thanks for your interest in joining the BLUE Leadership Programme organised by PM.Haze (People's Movement to Stop Haze). If you came here without knowing what you're signing up for, please check out the info at pmhaze.org/blue =)

Deadline for applications has been extended till 3 days before the respective workshop ie. till 17th March & 6th April!

This registration form should take no more than 15 minutes to fill in.

If you have any queries, please email Yi Han at yihan@pmhaze.org

Given name (First Name)
Your answer
Surname (Family name)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Mobile Number
Your answer
Email Address
Your answer
School
Either currently studying or soon-to-be studying (2017 intake)
Your answer
If not from or going to a school, which community can you reach out to?
Your answer
Gender
How did you hear about us?
Required
Assuming you continue to the BLUE Leader's phase, would you like to join the Malaysia Trip 21 - 24 July (4D3N)?
The expected cost of the trip will be $350 (inclusive of most meals plus all accommodation and transport)
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