YDA20 Ambassador Sign up form - Youth Diabetes Action

Name 姓名*

First Last

Date of birth 出生日期*

Age group 歲數組別

Telephone 聯絡電話*

Email 電郵地址*

Address 住址*

Street Address Address Line 2 City State / Province / Region Country

Name of school/college/university 學校名稱

Why do you want to become a YDA20 Ambassador? 為什麼希望成為YDA20大使？ (answer in no more than 100 words 請以不多於100字回答）*

Parent's name 父母姓名*

First Last

Parent's telephone no. 父母聯絡電話*

Parent's email 父母電郵地址*

Declaration 聲明*

I agree to the declaration. 本人同意以下聲明。

1. By signing up to become a YDA20 Ambassador, I am pledging to raise HK$10,000 as a donation for YDA. 本人承諾成為YDA20大使後，將籌募HK$10,000款項予兒童糖尿協會。
2. The funds raised for YDA are held on trust by each YDA20 Ambassador and will be paid to YDA as soon as reasonably possible, and by no later than 14 November 2021. 本人同意為兒童糖尿協會所籌得之款項將由YDA20大使以信託形式保管，並在合理時間內及不遲於二零二一年十一月四日前繳付予兒童糖尿協會。
3. I understand I will need to participate/volunteer and help promote the YDA 20th Anniversary events. 本人了解本人將會義務參與及宣傳兒童糖尿協會二十週年之活動。
4. I understand I have the personal responsibility to follow the social distancing measures in place at any particular time and take all necessary precautionary COVID-19 measures. 本人了解本人需履行個人義務，於任何特定時間均需遵守社交距離措拖，並採取任何有需要之2019新型冠狀病毒感染措拖。

YDA20 Ambassador YDA20大使