GLOBAL YOUTH MINISTERS 2011

PARTICIPANT APPLICATION FORM

(For FULL PACKAGE)

Application Deadline: 12 Jan 2011

PARTI PERSONAL PARTICULARS
Name: / (in English) /
(in Chinese)
(Alias)
Gender: / M F
Age:
Date of Birth:
Home Phone No:
Mobile Phone No:
Address:
Address (line 2) :
(District) / HKIslandKLN NT
Email Address:
Name of school : / (in English)
(in Chinese)
Form:
Interest(s):
Language: / Spoken / Written
1 / 2 / 3 / 1 / 2 / 3
English
Cantonese
Mandarin
Others, please specify:
1=Fluent 2=Good Command 3=Fair
PART II CHOICE OF REPRESENTATION
Please state your preference for the 3 most preferred countries that you wish to represent as follows:
1= First Priority 2= Second Priority 3= Third Priorityx= Not Preferred
Asia
1 2 3 x / Europe
1 2 3 x / Africa
1 2 3 x / America
1 2 3 x / Oceania
1 2 3 x
China / 1 2 3 x / Britain / 1 2 3 x / South Africa / 1 2 3 x / USA / 1 2 3 x / Australia / 123x
Japan / 1 2 3 x / Ukraine / 1 2 3 x / Sudan / 1 2 3 x / Canada / 1 2 3 x
India / 1 2 3 x / Germany / 1 2 3 x / Nigeria / 1 2 3 x / Brazil / 1 2 3 x
DPRK / 1 2 3 x / Egypt / 1 2 3 x / Mexico / 1 2 3 x
Iran / 1 2 3 x / Zimbabwe / 1 2 3 x / Peru / 1 2 3 x
United Arab Emirates / 1 2 3 x
PART III
Please select news related to global water crisis and write a short essay on it. (State your reason(s) for choosing that news and elaborate them with your comments.) (LESS than 200 words)
PART IV ADMISSION FEE
For payment method, please see [PART VIII – REMARKS]
for 2 people: HKD1,000 for 1 person: HKD 600
I DO NOT have a companion. I DO have a companion.
About your companion:
Name: / (in English)
(in Chinese)
Gender: / M F
PART V CURRICULUM VITAE
Please attach a ONE-page CV
containing your activity/scholarship records
PART VI EMERGENCY CONTACT INFORMATION
Name : / (in English) / (in Chinese)
Relationship:
Contact No.: / (1) / (2)
PART VII DECLARATION OF APPLICANT
  1. I declare that the information given in this form is complete, true and accurate, and I understand any misrepresentation of facts may lead to disqualification of the captioned event.
  2. I agree that should there be any subsequent changes of any information given in this form, I should inform the organizing committee immediately.
  3. I agree to the data usage of my personal information as a basis of selection of applicants and for the communication between the association and me.
  4. I understand that the organizing committee has the right to add or delete any workshops or sessions, or change the format or guests of any session without prior notice.
  5. I understand that the email is the common and most-frequently used means of communication between the organizing committee and me, and it is my responsibility to timely obtain all updates and information of the event from my email account.
  6. I understand that the organizing committee reserves the right to make all final decisions as to all kinds of arrangement of the programme.
Signature: / Date:
PART VIII REMARKS
  1. Please make photocopies of the application form if necessary.
  2. Please email the completed form to .
  3. A crossed cheque of the admission fee (made payable to "Hong Kong Young Leaders Development Association") must be sent to P.O. Box 72521, Kowloon Central Post Office, with the name and contact telephone number of the applicant written on the back of the cheque. Cheques will be cashed once the applicant successfully passes the screening process. Change of applicants or withdrawal could not be arranged once the application is successful. Application fees are non-refundable for successful applicants. Cheques will be returned to unsuccessful applicants.
  4. Successful candidates are required to attend all activities of the captured event.

Nota Bene: The information contained in this application form will only be utilised by organizations and groups participating in this event and will be deleted immediately after use.

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