YouthMAX Participant's Entry Form
Event Date / Timing: Saturdays 3:30-5pm (90mins)
5th Mar'22 Session#1 Stand Up Be Counted
12th Mar'22 Session#2 Failing Forward
19th Mar'22 Session#3 Self-Image
26th Mar'22 Session#4 Personal Character

Event Address: ZOOM platform
Contact Coach Jasmine & YouthMAX Team youthmaxmy@gmail.com or WhatsApp IEC +6019 5855 997
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Email *
Age *
Gender *
Your Name *
Your WhatsApp Mobile: *
Parent(Guardian) Name/s *
Parent(Guardian) Mobile Number *
Parent (Guardian) Email *
School, State & Country *
What do you hope to gain through attending YouthMAX? *
What are the challenges you are currently facing which you hope to find answers to? *
Ask minimum 3 questions you have about YouthMAX: *
How did you know about YouthMAXmy ? *
I understand that by submitting this form I will need to remit the following payment to confirm registration. Payment will be made to: IEC Heart for Arts Foundation, 100 3900 1012 2508 Alliance Bank Malaysia Bhd. All payment receipts are to be emailed to youthmaxmy@gmail.com with Participant's Name as Reference in the Subject Header. *
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Referral Code:
Privacy Policy
Coach Jasmine and her team under the John Maxwell Team are committed to keeping your personal details private and confidential. Anything shared in this form or during coaching sessions and assignments will be kept strictly private and confidential in accordance with the Personal Data Protection Act 2010 of Malaysia (“PDPA”).
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