INTERNATIONAL SCOUT PEACE CAMP 2013

Kwartir Nasional Gerakan Pramuka Jl. Medan Merdeka Timur No. 6, Jakarta 10110. Phones: +62 21 3507645, 3507646, Fax.No.: +62 213507647 e-mail : kwarnas@pramuka.or.id

APPLICATION FORM FOR PARTICIPANTS FOR INTERNATIONAL SCOUT PEACE CAMP 2013

1. Name of the Applicant (In Capital) 2. Fathers name 3. Name of Country 4. Home Address (In Capital)

Distt. 5. Telephone/Mobile No. 6. Date of Birth 7. Experience in Scouting

State E-mail Age in years

Postal Code

8. Have you attend any international Event If so, give details 9. Vegetarian or Non-Vegetarian 10. Special Hobbies or any other information

Signature of the Applicant

DECLARATION
I agree to adhere to the discipline of the movement and programme in particular and abide by the rules and regulations of the committee during the whole event. In case of any accident, illness, or injury, I will not hold Kwartir Nasional Gerakan Pramuka responsible at all. I further declare that I have not been in contact with any infectious disease for the past one month and that I am keeping good health & physically fit to undergo the International Scout Peace Camp Programme.

Signature of the Applicant