Registration Form Youth Day

Mention the total of days and dates, that you are going to live with your project if not for one week

16 June 2018 Youth Day Challenge to Top 100 SA Difference Makers *

Yes No

16 June 2018 Youth Day Challenge to Youth S.A. *

Yes No

Scheduled from Friday 8 June 2018 to Sunday 17 June 2018 during Youth Week 2018, mention the day/ days *

Mention the day/days, the date/dates that your group is taking part *

Name and Surname of participant (Top 100 SA Difference Maker) or appointed Organization

Mention the Names of co-leaders/colleagues that will join you to successfully roll out this initiative during Youth Week

Name *

First

Last

Name *

First

Last

Your Email *

Name *

First

Last

The school or youth group that you will serve with this initiative

Mention what you Register for:
1. The Total Program for one week (Apply for this program here) *
2. A one hour program during Youth week (Top 100 SA Difference Makers did receive the content of this program)
3. One Hour programs during Youth Week (Apply for this program here) *
4. Apply to Read the Rules and to comply to the rules of the total project

How many Blue Ribbons will you need to complete the project.... (Important Note: order your Blue Ribbons one week in advance)

How Many? *

10 Blue Ribbons 20 Blue Ribbons 30 Blue Ribbons 50 Blue Ribbons

I agree to keep to the rules of this challenge as is given on the work sessions that was held.

I agree to send video clips / and or / photographs of this project and collect authentic stories to DMI-SA not later than 25 June 2018

I agree to give recognition to DMI-SA on my proposals/ letters/ marketing material by using the logo that is supplied

Complete the following: