Taramindu

Beach Garden Inn, Laiya, San Juan, Batangas

September 22-24, 2017

Please type or print your answers in the space provided below

PARTICIPANT INFORMATION

First Name M.I. Surname

Nickname Birthday ( MM/DD/YYYY ) Gender

M F

Home Number Mobile Number Email Address

Home Address ( city ) Work Address ( city ) OccupaJon Church/religious aliaJon High School aMended

Emergency Contact Details

Name Contact Number RelaJonship to parJcipant

Are you a Dgroup/D12 Member Name of Leader Contact No. Of leader Who invited you?
Dgroup D12 None
Important reminder ( please read carefully and acknowledge)
While the organizaJon shall endeavor to take care of the needs and look aVer of the welfare of the parJcipants, the
parJcipant acknowledges that he/she is aMending the travel ouJng and will be parJcipaJng in the acJviJes at his/her own risk.
The parJcipant assumes full responsibility for any personal injuries , loss of property and damages of whatever nature sustained
for the duraJon of the ouJng, including travel to and from the venue. The parJcipant shall not hold the organizers liable , and
fully forever releases and discharges the organizers from any and all claims , demands,right of acJon or causes of acJon that may
accrue to the parJcipant on account of this travel ouJng.
Signature Printed Name Date

For more informaJon please contact: 0939-7243430

*Please send the completed application form to fghtravel2017@yahoo.com and bring a printed copy on September 22. Thank you!