YSEALI 5th Year Logo Contest

Registration

1. Name or User ID ________________________________________________

2. Country/Countries of Citizenship
________________________________________________
3. Country of Residence
________________________________________________
4. E-mail Address
________________________________________________
5. I am age 18 or older
Yes 
No 
6. If “no” box is checked above, I can provide written parental or guardian consent if I am
selected as a winner [and/or finalist].
Yes 
No 

Please note, if you are selected as a finalist and/or winner of the contest, it may be necessary to
collect additional information including: [real name, address, other necessary information
specific to the contest].

 Contestants must be 18-35 years old

 Must be a YSEALI member
 Must be a citizen of one of the following countries: Brunei, Cambodia, Indonesia, Laos,
Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste and Vietnam
 Must reside in one of the following countries: Brunei, Cambodia, Indonesia, Laos,
Malaysia, Myanmar, Philippines, Singapore, Thailand, Timor-Leste and Vietnam

[US Mission to ASEAN/YSEALI] 1 [YSEALI 5th Year Logo Contest]

Privacy Act Statement

a. AUTHORITIES: The information is sought pursuant to OMB M-10-11.

b. PURPOSE: The information solicited on this website will be used to evaluate and process
submissions to the YSEALI 5th Year Logo Contest and determine the eligibility of entrants.

c. ROUTINE USES: The information submitted to this website is collected on behalf of the U.S.
Department of State, and might be subject to the Privacy Act of 1974. The winner’s information may
also be made available to the public. More information on the Routine Uses for the system can be
found in the System of Records Notice STATE-79, Digital Outreach and Communications.

d. DISCLOSURE: Providing this information is voluntary. Failure to provide the information

requested on this website may result in ineligibility for the YSEALI 5th Year Logo Contest.

10/5/2018

[US Mission to ASEAN/YSEALI] 2 [YSEALI 5th Year Logo Contest]