Global Goals Summit 2019

Fields marked with an * are required

Full Name *

Full Name

Email *

Email Address

Age *

Age

Date of Birth *

DoB
DoB

Gender *

 Male
 Female

Nationality *

United States

Current Address *

Current Address

Phone Number (With Country Code. eg : +62 xxx xxx) *

+62 81xxx xxx

Whatsapp (With Country Code. eg : +62 xxx xxx) *

+62 81xxx xxx

Passport Number (If Any)

Passport Number

Passport Expired Date (If Any)

Passport Expired Date

Name of School/University/College/Work *

Name of School/University/College/Work

What do you think about generation unlimited? *

Describe here :

What will you do to support Global Goals and prepare for 2030? *

Describe Here :

Choose Your Council *

 Council 1 (No Poverty)

 Council 2 (Zero Hunger)
 Council 3 (Good Health & Well Being)
 Council 4 (Quality Education)
 Council 5 (Sustainable Cities & Community)
 Council 6 (Climate Change)
 Council 7 (Decent Work and Economic Grow)

Why do you choose that council? *

Describe Here :

What do you expect/want of attending this program? *

Describe Here :

Why should we choose you as the Global Goals Delegates? *

Describe Here :

Are you interested to be Global Goals Action Ambassador? *

 Yes
 No

If yes, what will you do after becoming the Global Goals Action Ambassador? *

Describe Here :

This program is SELF –FUNDED. So, who will financially support you to take part at this program? *

Describe Here :

Emergency contact (name and phone number) *

Parents (+62 81xxx xxx)

Where do you know information about this program? *

  Studec International/ Global Goals Summit (website & social media)
 Youth Opportunities (website & social media)
 Broadcast (whatsapp, line, telegram, email)
 Instagram
 Facebook
 Media partner
 Friends
 Others

I would like to register ... *

 Global Goals Summit 2019 - Program Only (Early Bird : $235 | Normal : $250)
 Global Goals Summit 2019 - Program With Accommodation (Early Bird : $335 | Normal : $350)

I hereby declare that I am participating in the Global Goals Summit in Kuala Lumpur, Malaysia, 20—22
January 2019 of my own free will and volition, having understood the risks involved in the above mentioned
activity. *

 Agree
 Disagree

Please Answer Below : 75+81 = *