CONFIRMATION FORM

* All information provided is correct upon confirmation

Program :Intercultural Camp

Program Date : Program Location :

Program Fee :
Confirmation Date :

*All the fields below are required for registration of this program. Your personal data will be collected and
used for the above program.

DATA PRIBADI
Full Name :
Gender : Male/Female Date of Birth :
E-mail :
Contact :
Passport Number :
Passport Expired Date :

Nationality :
University/ Institutional :
Facebook/Twitter :
Clothes Size : S/M/L/XL/XXL
Special Food : there is no/halal/vegetarian/if anything else
(Explain)
Special Illness : Yes/No

Emergency phone number :

Name :
Contact Number : Relations:
 CONFIRMATION FORM
* All information provided is correct upon confirmation

Terms and conditions

Participants must prove that they can participate in the Intercultural Camp Program and / or in good health
by attaching a health certificate.
Every person should be responsible for their own health condition.
The Intercultural Camp Committee reserves the right to change the content of the event with or without
prior notice.
Due to the limitation of available quota, only applicants with full payment are deserved to join the program.
If there is a dispute during the event, decisions made by the organizers are final, the program fee is not
refundable.

Personal Data
By signing below, you consent to the collection, use and / or disclosure of your personal information by IFS
for the purpose of organizing this event, and / or for analysis and research purposes only concerning
activities / programs.
Please update your data via thailand.interculturalcamp@gmail.com from any changes in contact details to
facilitate communication.

I will not hold the organizer responsible for damage or loss of property, accidents or loss of life that may
be experienced by me during any activity arising from any cause whatsoever with such event.

..., November 2017

Participant ofIntercultural Camp,

Sign

(Full Name)