CONFIRMATION SLIP

I would like to signify and confirm my participation in the MindaNOW SK SUMMIT 2022:
Panagtapok, Pakighinabi, Panaghiusa on December 5-8, 2022.

Moreover, I understand that once my participation has been confirmed and accepted, I am
responsible for paying the costs for the allocated slots if I do not use the food and
accommodation provided by the National Youth Commission.

Below are my travel and personal details:

Mode of Transportation: By Air / By Land By Sea

(Choose all that applied)

Please list any medical conditions that may affect your participation to the training (This
includes allergies, asthma, past or present injuries and/or surgeries):

JASMIN C. BALABAGAN 11/21/202

Signature Over Printed Name Date

SK Position SK Municipal Federation President Sex Female

Local Government Unit LGU-SULTAN MASTURA
(Ex: Brgy. TALOMO PROPER, DAVAO CITY,
DAVAO DEL SUR)
Contact 0945-824-5765
Number/s
Email Address/es Balabaganjasmin@gmail.com

EMERGENCY CONTACT
Name Mohammad M. Balabagan Relationship Father
Address Brgy. Balut, Sultan Mastura, Contact Number/s 0995-511-7888
Mag.

Note: Kindly convert this file to PDF and upload this form when applying through the pre-registration
link: https://tinyurl.com/MindaNOWSK