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The 2 Asia 4-H Network Conference, Taiwan, R.O.C. (Nov. 27 - Dec.3, 2016) Participant Form
The 2 Asia 4-H Network Conference, Taiwan, R.O.C. (Nov. 27 - Dec.3, 2016) Participant Form
R.O.C.
This
participant
H Network
and give
Home
Country:
Flight Schedule:
Arrival date, time and flight no.
Departure date, time and flight no.
(Note: Free bus services is available only on Nov. 27, 2016 from Taiwan Taoyuan
International Airport to Mellow Fields Hotel in Taipei, and is also available only on
Dec. 3, 2016 from Mellow Fields Hotel to Taiwan Taoyuan International Airport)
PERSONAL DETAILS:
Family name:
First name:
E-Mail:
Mobile phone:
Telephone no.
Fax no.
Mailing Address:
Place of residence: City, Town, Rural, Farm
Person to contact in case of emergency:
Telephone no.
Mobile phone:
Religion:
( ) Christianity, ( ) Catholicism, ( ) Muslim, ( ) Buddhism, ( ) Hinduism,
( ) Sikhism,
( ) other:
Education:
(
) Graduated school,
) University or College, (
4-H:
(
) Agent, (
) Member, (
) Volunteer
1
) High school
Languages:
Very good
English
Chinese
Good
Fair
Little
Other information (Food you cannot eat or allergies, vegetarian, meat and
vegetable dish, etc.)
.
Insurance: Every participant is responsible for her/his own insurance.
I do have an insurance policy for this conference.
Signature:
Date:
Participant fee: (
2016 ), or
(
SWIFT CODE:
UWCBTWTP
BENEFICIARYS NAME: NATIONAL 4-H CLUB ASSOCIATION, R.O.C. ACCOUNT NO.
030087085755
Note: After fill in the form, please email it no later than September 10, 2016 to:
Miss Sophie Chen, National 4-H club Association, at E-mail:
82812sspp@fourh.org.tw
The following information is only for Country organizer to fill in:
4-H Exhibitions Display List (Please list the things you like to display in 4-H
Exhibition (for a 180cm 60cm table), and please prepare at least two
questions for the Challenge Activity):