YOUTH FOR PEACH UNION

INTERNATIONAL YOUTH FOR PEACE CONFERENCE

REGISTRATION FORM

A. Personal Identity
1. 2. 3. 4. 5. %. (. +. 9. Surname:
(As appeared in passport)

Middle Name: :

given Name:

Full Name
(As appeared in passport)

Sex Name to appear on ID Badge

(Dr./Mr./Mrs./Ms)

: _________________________________________ : : : : :

a!!port Num"er#ID N$ &ountr' $rgani)ation i* an' De!ignation

arti,ipant-! o!ition (Please select one of the following)

.ead o* $rgani)ation Mem"er o* $rgani)ation

1/. 0ddre!! 11. 1elep2one 12. Fax 13. 34mail 14. 15itter 15. Fa,e"oo6 1%. Dietar' re7uirement! i* an'

: : : : : : :

The International Youth for Peace Conference will be held on January 24, 2014 at Taman Mini Indah , Jakarta, Indone ia

YOUTH FOR PEACH UNION

B. Financing and Sponsorship Sele,ted appli,ant 5ill "e a5arded !,2olar!2ip8 2o5ever due to limited *und!9 5e en,ourage 'ou to *ind !el*4*inan,ing !upport to attend t2i! ,on*eren,e. 12e organi)er :ill !end 'ou an a,,epted and invitation letter to !u"mit to 'our potential donor!. 1. 0re 'ou *ull' !el*4*inan,ing ;in,luding *lig2t!8 a,,ommodation8 meal!8 and airport pi,6up#drop o**<. a. =e! ". No 2. 0re 'ou partial !el*4*inan,ing> lea!e !pe,i*' area! 52ere 'ou ma' re7uire !upport.

C. Please ans er the !ollo ing "#estions in $% ords or less& NB: Selection of participants will be ade based on !o"r written responses ta#ing into acco"nt the need to ens"re gender$ di%ersit!$ geographical and the atic balance etc. a. : 2 a t i! t2e purpo!e o* 'our parti,ipation at t2i! ,on*eren,e>

". .

lea!e de!,ri"e 'our organi)ation.

,. .o5 do 'ou intend to di!!eminate and implement t2e out,ome! o* t2i! ,on*eren,e at national and#or regional level!>

d. De!,ri"e 'our po!itition#!tatu! in 'our orga7ni)ation.

'.

lea!e 5rite an e!!a' minimum 3 page! a"out t2e Follo5ing!: 1<. ea,e and Development 2<. ea,e and ?e*ugee! 3<. ea,e and Di!a!ter 4<. ea,e Building . &2oo!e 1 topi, *rom t2e given topi,!.

Applicants are kindly requested to send their completed Registration Form & Copy of Passport by email to yfpu2 !"#gmail.com$ before January 10, 2014.. Please send the file as follo%ing format& Country' (assy )opic' Applicant *ame +America' Peace ,uilding'RimaThe International Youth for Peace Conference will be held on January 24, 2014 at Taman Mini Indah , Jakarta, Indone ia