EVENT REGISTRATION FORM
EVENT REGISTRATION FORM *All information provided are correct at time of registration PARTICIPANT Event Name : Youth Entrepreneurship Symposium 2015 (“YES 2015”) Date : 17 June – 19 June 2015 Registration Fee : $20 (nEbO Member) | Promo Code (Official Use Only) : ___________________________________ ( ______ years, $ ______ ) Receipt Number (Official Use Only) : ___________________________________ Time : 8.00am – 6.00pm $25 (Non - nEbO Member) (Circle where appropriate) All fields below are required for registration of this event. Your personal data will be collected and used for the event as mentioned above. PERSONAL PARTICULARS Full Name : __________________________________ Gender : Male / Female (Circle where appropriate) Email : __________________________________________ Contact No : _________________________ Address : _______________________________________________________________________ School : __________________________ T Shirt Size : XS/S/M/L/XL/XXL (Circle where appropriate) Special Dietary Requirements : None/Halal/Vegetarian/Others (Circle where appropriate) If others, please specify:_________________) Any Medical Conditions : Yes/No (Circle where appropriate) nEbO Member : Yes / No (Circle where appropriate) (HP) NRIC/FIN : ____________________________ Date of Birth : ________________ __________________________ (DD/MM/YYYY) (Home) If yes, please specify:____________________) EMERGENCY CONTACT PERSON (nEbO will contact this person in the event of an emergency) By filling up the information below, you declare that you have obtained consent from your emergency contact for nEbO to collect, use, and disclose his/her personal data in case of emergency. Name : Contact No : Relationship (HP) : (Home) (DD/MM Terms & Conditions Participants will have to indicate their medical history/conditions in the field above. Each individual will have to take personal responsibility to their own health condition. All participants have to be Singaporeans whom are non working individuals between ages of 12 to 25 years old. nEbO reserves the right to change the content of the event with or without prior notice. Due to limited places available, only registrations with full payment / complete information made are deemed as confirmed on a first come first served basis. All registered participants for this event will be contacted via email or telephone for further confirmation of their particulars. In the case of any disputes during the event whenever applicable, the decision made by the organizer is final. Personal Data By signing below, you consent to the collection, use and/or disclosure of your personal particulars by nEbO for the purposes of organising this event, and/ or uses by nEbO for analysis and research purposes pertaining only to matters in relation to such events/ programmes. All registered participants will be included into the contact list of nEbO, to receive regular updates on future engagement events and programmes organised by nEbO, as well as opportunities to contribute, share opinions and/or feedback. In the event that registered participants do not wish to receive regular updates on future engagement events and programmes organised by nEbO and NTUC Club, as well as opportunities to contribute, share opinions and/or feedback, please inform and provide clear instructions to nEbO in writing at [email protected] within 14 days from event date itself. nEbO will subsequently be unable to inform you of subsequent engagement events. Any photographs, motion pictures, recordings, or any other media records of this event may be used by nEbO for any legitimate purpose, including any commercial and marketing uses, and/ or to be uploaded onto nEbO’s media sites and channels. In the event that registered participants do not wish for his/her photographs and/or any other media records of him/her at this event to be used by nEbO, please inform and provide clear instructions to nEbO in writing at [email protected]. Please update nEbO at [email protected] of any changes in contact details so as to facilitate communication. Terms & Conditions of nEbO Membership (Only applicable for events which includes nEbO membership) Please ensure all details provided are accurate, an administrative fee of $10 will be imposed for any card replacement due to wrong information provided. Please allow 3 – 4 weeks for us to mail your nEbO Plus! Card and Welcome Pack to your mailing address. No refund whether full or partial will be given once payment is made. The 1 year nEbO membership is only applicable to non-working individuals aged 12-25. The 2 years nEbO membership is only applicable to non-working individuals aged 12-24. The 3 years nEbO membership is only applicable to non-working individuals aged 12-23. I understand and agree that by becoming a nEbO member, I also become a member of the PLUS! Programme administered by NTUC Link Private Limited. The nEbO Plus! Card will ONLY be Link activated after 5 working days from when the card is printed. Kindly refer to http://www.ascentis.com.sg/nebo_cso/signup/tnc.htm for the Terms & Conditions of the usage of the nEbO card. For more information, please refer to our privacy policy found at http://www.ntucclub.com/privacy. No photo is required for the nEbO membership card. I shall not hold the organiser responsible for any damage or loss of property, injury or loss of life which may be sustained by me during the activity arising from any cause in connection with the event. I also undertake to indemnify the organiser against any claim by any part in connection with the activity. Please acknowledge and sign a copy of the Indemnity Form (Annex 1). Signature : Full Name : Date : Indemnity Form [Annex 1] Organiser : nEbO Declaration I solemnly DECLARE by virtue of the provisions of the Oaths And Declarations Act 2000, and subject to the penalties provided by that Act for the making of false statements, that (a) I/We have sought medical advice and I/We have not been advised otherwise by any medical practitioner that I am/We are physically and mentally not fit or not able to take part in the activities and events; and (b) All information provided by me is true to the best of my knowledge. Signature : Full Name : NRIC No : A. For participant at and above the age of 18 IN CONSIDERATION OF YOU having at my request agreed to accept my participation in the activities and events organized by you and or your authorized organizing agent and to grant access to me to the site of activities and events as participant for the activities and events and or as visitor for other purposes, I, _________________________________________, holder of NRIC/Passport No. __________________, HEREBY RELEASE AND DISCHARGE you and or your authorized organizing agent or any other persons authorized by you and or your organizing agent from all claims that I or my personal representative(s) and dependent(s) may have for injury (including injury resulting in loss of life) however caused sustained by me and for loss of or damage (however caused) to my personal belongings suffered at any time while taking part in the activities and events as participant or as visitor, while within the site of the activities and events for any purpose whatsoever. Name and Signature of Participant Date B. For participant below the age of 18 IN CONSIDERATION OF YOU having at my request agreed to accept participation by my child named below in the activities and events organized by you and or your authorized organizing agent and to grant access to my child to the site of activities and events as participant for the activities and events and or as visitor for other purposes, I, _______________________________, holder of NRIC/Passport No.___________________, being the legal guardian of _________________________________, holder of NRIC/Passport No. _______________________, HEREBY RELEASE AND DISCHARGE you and or your authorized organizing agent or any other persons authorized by you and or your organizing agent from all claims that my said child may have for injury (including injury resulting in loss of life) however caused sustained by my child and for loss of or damage (however caused) to his/her personal belongings suffered at any time while taking part in the activities and events as participant or as visitor, while within the site of the activities and events for any purpose whatsoever. Name and Signature of Parent/Guardian Date Rules and Regulations Youth Entrepreneurship Symposium 2015 (“YES 2015”) 1. Event Details Name Date Time Registration fee : Youth Entrepreneurship Symposium 2015 (“YES 2015”) : 17 June 2015 - 19 June 2015 : 8.00am to 6.00pm : $20 (nEbO member) | $25 (non-nEbO member, inclusive of nEbO membership) (non-nEbO member: receive up to 3 years membership depending on age - 25 yrs old = 1 year membership, 24 yrs old = 2 years membership, 23 & below = 3 years membership) 2. Registration Details You may sign up as a team of 5 OR as an individual to be placed in groups with other participants. Please provide the names of the team members if you are signing up as a team in the table below: Name of team members Hp No. You may register via Online or Offline o Online registration via nEbO website (http://www.nebo.sg/) Online payment can be made via debit card A confirmation email will be sent to successful applicants o Offline registration Only CASH payment is acceptable. Kindly email to Suk San ([email protected]) or Cindy ([email protected]) to arrange an appointment for cash collection Register for the Workshop Talks on a first-come-first served basis o The event organizer reserves the right to amend the event programme o Please rank your choice of preference for the talks of each workshop in the table below (1 is most preferable and 4 is least preferable) Event Date Workshop Talk Details WORKSHOP 1 Building Confidence Effective Communication Habits of Success Power of Influence WORKSHOP 2 Idea Generating Leadership Building Strength How to Build a Good Team WORKSHOP 3 Financial Literacy Business Legal Branding Presentation Essentials WORKSHOP 4 E-Commerce Hardware Social Enterprise Retail Rank your choice of preference 17 June 18 June 3. Contact Details Should you require further information, feel free to email us @ [email protected] or contact us: Name Khalid Hanafi Lip An Alex Contact Number 91077477 94871538 96999538 81119345 Navin 84371475
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