Participant Form
Thank you for your participation for the 1st 4-H Global Leadership Camp 2019, Sept. 23- 28, Jeju, Korea. Please email the filled out form to bluetrain90@hanmail.net until July 31th, 2019.

Please insert
your Photo
(3 X4cm)

 (9cm X 6cm)

Participant Category	
□ 4-H Active Country	
□ 4-H Program CEO/Secretary General
□ 4-H Chief Marketing Officer
□ 4-H Youth Representative
□ 4-H Educator/Program Leader
□ Etc (                           )	
□ IFYE Country	
□ IFYE Representative(President)
□ IFYE Leader(Secretary General, Board member)
□ IFYE Member(Alumni)
□ Etc (                         )	
□ Rural Youth Club Country	
□ Rural Youth Club Representative
□ Rural Youth Club Official
□ Rural Youth Club Sponsor
□ Etc (                          )	
□ 4-H Non Active Country	
□ Representative from Ministry of Agriculture (Government)
□ Professor who are related to Agriculture or Rural Youth
□ Etc (                         )	

Personal Information	
First Name		
Last Name		
Nationality		
Gender/Age	/	
Passport No.		
Address		
Phone :
(Mobile)		
Phone
(Office or Home)		
E-mail	or	
Education & Major
(The Highest		
Organization		
Position		
Mother Tongue
(Language)		
	Very Good	Good	Good	Fair	Little	
English						
Korean						

The reason why I participate in the 1st 4-H Global Leadership Camp 2019 is, 

                                                                                                                        

                                                                                                                        

4-H (or IFYE, Rural youth) Background

                                                                                                                        

                                                                                                                        

                                                      

Any other information (Food you cannot eat or allergies etc)

                                                                                                                        

                                                                                                                        

                                            

<Important Note>
-	Please be informed that we can only provide your accommodation and meal from a day before the Camp (Sep. 22, Dinner) until the end of it (Sep. 28, Breakfast). Any other expenses; transportation costs and accommodation fees before and after summit should be self-funding.
-	Every participant is responsible for their own insurance (Please send us a copy of your policy until August. 30)
-	Every participant should agree with the objectives of this Camp and follow meeting principals of the Camp and follow the schedule of the Camp.
-	Every participant should not do any illegal actions in Korea.

I certify that the statements made in answer to all the above are true. I understand that any misrepresentation or omission made in this Participant Form may render my participation invalid. I have read important note and accept them in principle.

Date (day/month/year) : 		               
Name :                                      
Signature :