Yes Camp 2008 Registration

DISTRICT 308 B1 LIONS YES CAMP 2008 INDIVIDUAL REGISTRATION FORM PERSONAL DETAILS NAME : _________________________________________ _______________SEX : MALE / FEMALE ADDRESS :_______________________________________________________________________________ TOWN/CITY : _______________ ________POST CODE : __________ COUNTRY : ____________________ TELEPHONE : ______________________ MOBILE : ______________ _____FAX : ____________________ DATE OF BIRTH : _______________ ____IC NO. : _______________ ____Email : ____________________ ANY ALLERGY/MEDICAL CONDITION : YES / NO Please specify if YES :______________________________________________________________________ VEGETARIAN : YES / NO T-SHIRT SIZE : ( S / M / L / XL / XXL ) (Please circle your preference) Have you participated in a YES Camp before? YES / NO

If YES, number of times attended _________

FOR NON-LEOS NAME OF LIONS CLUB : ___________________________________________________________________ DISTRICT : ___________________ REGION : ____________ ZONE :________________________________

FOR LEOS NAME OF LEO CLUB : _____________________________________________________(ALPHA / OMEGA ) DISTRICT : ___________________ REGION : ____________ ZONE :_______________________________ SPONSORING LIONS CLUB : ______________________________________________________________ NAME OF LEO ADVISOR : _______________________________ TEL NO. _________________________ SIGNATURE : _________________________________________ DATE : ___________________________

TRANSPORT INFORMATION ARRIVAL

(PLEASE CROSS (x) ONE)

DEPARTURE

(PLEASE CROSS (x) ONE)

Will meet at KL Sentral Station Bus departure time is 8.30 a.m. SHARP

Will take bus back to KL Sentral Station

Will go to Camp site by own transport Arrival time is 10.30 a.m. SHARP

Will be leaving by own transport

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Please submit the completed forms with payment (RM 300.00) by 27 November 2008 to:

The Organizing Secretariat, DISTRICT 308B1 LIONS YES CAMP 2008 No. 1, Jalan PJU 1A/8, Taman Perindustrian Jaya, 46050 Subang Mobile: 016-2728521 (Lion Wong Chooi Chen)

FOR OFFICE USE ONLY Date Received : __________________ Receipt No : _____________________ Registration No : __________________

SECTION A: TO BE FILLED BY PARENT / GUARDIAN OF PARTICIPANTS BELOW 18 YEARS OLD I hereby permit my son / daughter / ward to participate in the LIONS 308B1 YES CAMP 2008 with the knowledge that the Organizing Committee has taken all precautionary measures and will not be held responsible for any mishaps, injury and / or loss resulting directly / indirectly from his / her participation in this Camp and also indemnify the organizers and parties related to it against any claims made by any party in connection with the activity. NAME : _______________________________________________________________________________________ RELATIONSHIP : PARENT / GUARDIAN (Please delete whichever is not applicable) SIGNATURE : _____________________________ IC No. : _________________________ DATE: ______________

SECTION B: TO BE FILLED BY PARTICIPANTS 18 YEARS OLD & ABOVE I, (NAME) ____________________________________________ shall not hold the Organizing Committee, its appointed staff and / or officials liable for any mishaps, injury and / or losses resulting directly / indirectly from my participation in this Camp and also indemnify the organizers and parties related to it against any claims made by any party in connection with the activity. SIGNATURE : _____________________________ IC No. : _________________________ DATE: ______________

PERSON TO CONTACT IN CASE OF EMERGENCY: (To be filled in by all participants) NAME : ____________________________________________________________________________________ RELATION TO PARTICIPANT :_________________________________________________________________ ADDRESS : ________________________________________________________________________________ TEL: ___________________MOBILE: ______________________

I hereby declare that all information provided in this Form is true and correct. I will abide by the Rules and Regulations set by LIONS 308B1 YES CAMP 2008 Organizing Committee at all times. I understand that the registration fee is non-refundable. A substitute qualified participant may be allowed upon request which must be accompanied by a separate Registration Form, submitted on or before 27th November 2008. What do you hope to achieve / gain by attending this Camp? ___________________________________________________________________________________________ ___________________________________________________________________________________________ NAME OF PARTICIPANT : _____________________________________________________________________ SIGNATURE : _________________________________________ DATE: ________________________________

Enclosed Cheque No: ____________ ______for RM ___________ crossed payable to: “LIONS CLUBS INTERNATIONAL DISTRICT 308B1” being payment for the above participation.