CLOSING DATE: 9TH JUNE 2013

UKULELE JAM
SINGAPORE EXPO 15th & 16th June 2013 PARTICIPATION FORM
Center: ____________

PARTICIPANTS PARTICULARS SECTION I: PARTICIPANTS PARTICULAR Name: __________________________________________________ Age: ________________ NRIC / Identification Number: ____________Date of Birth (DD/MM/YY) ____________________ Email Address: ___________________________________________________________________ Mobile Number: ________________________ Gender: Male Female )

Residential Address: ___________________________________________Postal Code ( SECTION II: PLEASE TICK THE BELOW UKE JAM SESSSION

Ukulele Jam Sessions 1 on 15th June 2013, Saturday) and Session 2 on 16th June 2013, Sunday ( Each participant will receive Free $20.00 Cristofori Cash Voucher) Ukulele Jam Session 1 on 15th June 2013,Saturday (Each participant will receive Free $10.00 Cristofori Cash Voucher) Ukulele Jam Session 1 on 16th June 2013 , Sunday ( Each participant will receive Free $10.00 Cristofori Cash Voucher) SECTION III: PARENT / GUARDIANS CONTACT (For Participants below 18 years old) Father/Mother/Guardians Name: (Mr/Mrs/Mdm*)_______________________________________ Fathers Mobile Number : ____________ Mothers Mobile Number ___________________________ SECTION III: INDENMNITY & PARENTALS / GUARDIAN CONSENT FORM I (the Participant) have read and accepted the Rules & Regulations of Ukulele Jam. I consent to the above participant, who is my child/ ward* participating in the Ukulele Jam. I have read and accepted the Rules * Regulations of Ukulele Jam. I hereby indemnify and agree to keep the organizer of the event fully indemnified against all claims, loss or damage whatsoever in respect of myself / childs /wards* death, injury, disability, or any loss or damage whatsoever from any cause in connection with his/her participation therein.

________________________________________ Participants / Parents / Guardians* Signature

__________________________ Date

*Please delete appropriately