REGISTRATION FORM : International Seminar, Scrabble and Chess Olympiad (ISSCO) in ASEAN Youth Camp MALAYSIA 2019
Please fill in the form for every single participants.
Please vivit https://www.sciencejohor.com and https://www.aeisa.org for more information an inquiries.
Your response much appreciated
1.0 Nationality *
2.0 School's / Institution's Name *
Your answer
2.1 School Phone Number
Your answer
2.2 School's email address *
Your answer
2.3 School's website / portal *
Your answer
3.0 Position *
4.0 Male @ Female *
5.0 Participant's Passport Number *
Your answer
5.1 Name stated in Passport *
Your answer
5.2 Passport Expiration Date *
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6.0 My general state of health is: *
6.1 Special Dietary *
6.2 My level of fitness is : *
6.3 Are you taking medication ? *
6.3.1 If YES, please specify :
Your answer
6.4 Have you been hospitalized in the past 12 months ? *
6.4.1 If YES, please provide details :
Your answer
6.5 Do you suffered from any of following condition or disorders? *
Required
7.0 Declaration and consent *
Required
7.1 Declaration and Indemnity Form *
Required
7.2 Medical and Emergency Information *
Required
7.3 Medical and Emergency Information *
Required
7.4 Medical Expenses and Reimbursement *
Required
8.0 Arriving Airport *
8.1 Date and Time of Arrival *
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Time
:
8.2 Departing Airport *
8.3 Date and Time of Departure *
MM
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DD
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YYYY
Time
:
9.0 Payment reference number (Telegraphic Transfer Receipt) *
Your answer
9.1 Date of Payment *
MM
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DD
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YYYY
Time
:
10.1 Shirt design *
10.2 Shirt Size
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