Leo Leadership Camp 2011

3rd November 2011 8th December 2011

Kem Bina Semangat, Kuala Kubu

Bharu
10th October 2011
Dear All,
Re: LEO LEADERSHIP CAMP 2011
Enclosed herewith is a set of Official Registration Form for the LEO LEADERSHIP CAMP 2010, to be held
in Kem Bina Semangat, Kuala Kubu Bharu from 3rd November 2011 to 8th November 2011.
Registration for Leo is RM265 per person; inclusive of 5 nights accommodation, 5 breakfasts, 6 lunches, 5
dinners & Insurance.
Attached is a set of forms: Registration Form
Indemnity Form
Summary of confirmed Participants - to be completed by the respective Club President
Kindly return the completed forms, duly signed, no later than 31st October 2011
1. Registration Form
2. Indemnity Form
3. Summary of confirmed Participants
Note: ALL PARTICIPATING CLUBS MUST BRING ALONG THEIR RESPECTIVE CLUB
BANNER.
Thank you.

Yours sincerely,

------------------------------------------Leo Leong Wai Yew

Organizing Chairperson
Leo Club of Petaling Jaya Integrity
Tel: 016-6292685
Email: leong_wai_yew@hotmail.com

Leo Leadership Camp 2010

A. Personal Information
Name of Participant: ____________________________________________________
NRIC No.
:______________________
Date of Birth
:______________________ Age
:_____________________
Gender
:Male/ Female
Religion :_____________________
Weight
: _______ kg
Height
:________ cm
Swim
: YES/NO
Hobbies
:_____________________
Home Address
: _____________________________________________________
_____________________________________________________
Telephone
: _________________ (H) H/P No.
:_____________________
Email
:_____________________
Blood Type
: _____________________ Allergies :_____________________
Other Ailments
: _____________________
Medication (if any) : _____________________________________________________
Diet
Special Diet

: Normal / Vegetarian / Others

: _____________________________________________________

Name of parent / guardian: _________________________________(Father/Mother)

Telephone No.
: ___________________ (H) ___________________ (O)
H/P No.
: ______________________
Email
: ______________________
Fax: _________________
Leo Club/ School

: _________________________________________________

______________________
Signature of Participant

______________________
Date

A. PARENTAL CONSENT (PERMISSION)

I, ______________________, (______________________) of _________________________
(Name & Relationship)

(Name of Participant)

NRIC No. _______________________________ *allow/disallow ______________________

To participate in this Leo Leadership Camp from _______________ to _________________.
(Date)
__________________________
Signature of Parent/Guardian
NRIC No.
: ______________________
Date
: ______________________

Organizing Chairperson Leo Leong Wai Yew (016-6292685) leong_wai_yew@hotmail.com

Leo Advisor
Lion Ivan Ho (012- 3915 993)