Form Delegate - Climate Ranger

Full Name

Age

Date of Birthday

Gender

Female Male Rather not to say

Province

City

Phone Number

Contact details of reference/recommender (name & contact number of the person providing recommendation)

Affiliated Community/Organization

Link to your affiliated community/organization (Instagram/website/others)

Are you currently a student or professional?

Student Professional

Do you identify yourself as a person with a disability*

Yes No

If yes, please specify the type of disability and let us know if you require any specific support or accommodations during the event

Do you identify as a Most Affected People and Areas (MAPA)?

Yes No

If yes, which MAPA group do you belong to?

Have you ever participated in any climate-related events or initiatives?

Local (city/provincial level) National International Never

If yes, please list up to 3 of the most impactful events or achievements you’ve been part of:

You may include speaking roles, organizing experiences, recognitions, or other contributions

Please rank the following topics based on your level of interest or passion (1 = most passionate, 3 = least)

Upload your documents (PDF)

The main conference of LCOY Indonesia 2025 will be held offline in Jakarta. Please indicate your funding readiness for transportation, accommodation, and other expenses. What is your funding readiness if selected as a delegate to attend the main conference in Jakarta? (You may select up to 2 options that best reflect your current funding situation)

Fully funded – I can only attend if all expenses (transportation, accommodation, etc.) are fully covered by the organizers. Partial funding – I am able to cover part of the expenses and will require partial support from the organizers. Self-funded – I am able and willing to cover all expenses on my own without financial support from the organizers.

Delegate Registration Form

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