PERSONAL & PROFESSIONAL QUESTIONNAIRE (CONFIDENTIAL)

Your information will be needed for verification purposes, to personalize your experience, better respond to your individual needs, and for the purposes set out in the Data Protection Notice

- Step 1 of 10

Name on Nametag: *

First

Last

FULL NAME *

The FULL NAME you submit will appear on your Certificate. Please TYPE in UPPER CASE and ensure the spelling is correct. A replacement certificate will be chargeable at $10. Your Money & You® Certificate is your "passport" to enjoy unlimited Free Review anywhere in the world, in any language.

Birthday: *

Nationality: (country of origin) *

Gender: *

Male
Female

Marital status: *

Single
Married
Others:

Meal Preference: (Please stick to your chosen meal preference for all 4 days) *

Vegetarian
Non-vegetarian / Halal

Please indicate if you have any special dietary requirements or food allergies

Personal Mobile Number: (with country & area code) *

Please use your personal Mobile Number (not office phone number) as we will also be using the last 4 digits of your mobile number to verify you as a Money & You® Graduate - Please keep us updated if you change your phone number.

Mailing Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Personal E-mail: *

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Your Profile: *

Business Owner
Student
Employee
Self-employed
Others (please state)

Company Name:

Designation or Work Scope

What business are you in / What's your strengths or area of expertise? *

How long have you been in business/working? *

Less than 1 year
1 – 5 years
5 - 10 years
10 – 20 years
More than 20 years

Current Annual Income?

Under $50,000
$50,001 - $80,000
$80,001 - $120,000
$120,001 - $300,000
$300,000 - $500,000
Over $500,001 - $2 million

Current Annual Company Turnover?

Under $100,000
$100,000 - $300,000
$300,001 - $500,000
$500,001 – $2 million
$2 million – $10 million
Over $10 million - $50 million

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Please indicate how you found out about the program : *

e.g. Website , Referred by friend/family and etc

If you were referred, who introduced you to Money & You® - (Name & Phone)

What made you decide to join the Money & You® Program? *

What would you like to learn or gain from the Money & You® Program? *

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HEALTH CONDITION QUESTIONNAIRE

1. Are you under the care of a Physician or a Psychiatrist? Have you ever been hospitalized in a mental institution for any reason? *

(If yes, for what condition?)

2. Are you receiving medication? *

(If yes, please list)

3. Have you had any history of heart trouble, rheumatic, covid, diabetes, asthma, kidney or liver involvement, epilepsy, bleeding disorder, or brain injury? (If yes, please tick the condition) *

No
Heart trouble
Rheumatic
Covid
Diabetes
Asthma
Kidney or liver involvement
Epilepsy
Bleeding disorder
Brain injury

4. Are you allergic to any medicine? *

(If yes, please list)

5. Have you had any serious illness or surgeries that we should know about? *

(If yes, please list)

6. Please list any medical history, or conditions that could interfere with your full participation in program activities eg. late evening sessions, pregnant (how many weeks):

7. Have you been fully vaccinated* or within the 180-day exemption period after recovery from COVID-19 *

*An individual is considered fully vaccinated if he/ she (a) has received the full regimen of a WHO EUL vaccine, or (b) within the 180-day exemption period after recovery from COVID-19. From 14 February 2022, participants resident in Singapore aged 18 years and above and who have completed the primary vaccination series will be considered fully vaccinated for up to 270 days after the last dose of the primary vaccination status. Thereafter, such participants who are eligible for booster vaccination must do so in order to remain fully vaccinated. Refer to https://file.go.gov.sg/vdsmminfo.pdf for more details on vaccination status.

Emergency Information: Name, Phone, Relationship *

To contact in case of emergency:

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MONEY & YOU® AGREEMENTS

CONSENT AGREEMENT *

I understand that the organizer (Globe Success Learning Sdn Bhd) may or may not audio and/or videotape the Money & You® Program. I consent to and authorize organizer to use my name, voice, appearance, image, words and participation in whole or in part in these recordings and any future correspondence or other derivative materials based on them, and I understand that the organizer intend to use them for educational, promotional and commercial applications.
I understand that the organizer does not have any obligation whatsoever to use all or any part of my participation in the program and the organizer may edit any audio or visual recording of my participation at the organizer’s discretion. The organizer shall have the right to reproduce, advertise, and publicize my participation in these materials without compensation to me. I agree that the organizer shall own all rights, title, and interest, including copyright, in and to the originals and all copies of such audio, visual or written recording.
I understand that if I do not wish to be recorded or photographed, I will request not to be recorded during the program or before speaking.
I understand that Money & You® is a private experience for every participant. I agree that all remarks and actions of participants are confidential and will not be used against the participants during or after Money & You®.

This release shall be governed in accordance with applicable laws; it may be amended only in writing, and constitutes the entire Agreement of the parties with respect to its subject matter. In the event of litigation, the prevailing party shall be entitled to recover its costs and attorneys’ fees.

DATA PROTECTION POLICY *

I acknowledge that I have read and understood the Data Protection Notice

Click here to refer the Data Protection Notice https://tinyurl.com/GSL-DataProtection

PLEASE TICK THE RELEVANT BOXES BELOW IF YOU AGREE TO RECEIVE THE FOLLOWING MARKETTING MATERIALS: *

I do not wish to receive any marketing information.
I would like to receive information about the goods and services which may be provided by Globe Success Learning, including (but not limited to) offers, promotions and information about new goods and services, via the following channels:
Newsletter
Email
Text messages
Telephone calls

MONEY & YOU® INTELLECTUAL PROPERTY AGREEMENT

The Money & You® Program consists of games, lectures, debriefs and DISC analysis. The teaching materials in the Money & You® Program are the Intellectual Property of Dame Doria (DC) Cordova who transacts business through Global 888 Enterprises, Inc. To safeguard the integrity and quality of the program, we ask your agreement to the following

MY OBJECTIVE IN JOINING THE MONEY & YOU® PROGRAM IS SOLELY FOR PERSONAL DEVELOPMENT AND LEARNING. *

I agree not to do any form of recording during the Program and will not duplicate any related material from the Program or games played in the Money & You® Program, without the written consent of Dame Doria (DC) Cordova.
I understand that the Money & You® Program is owned by Dame Doria (DC) Cordova / Global 888 Enterprises, Inc. and that the only recognized promoters are:

▪️ Globe Success Learning Sdn Bhd (English) in Malaysia with associates in Singapore, Cambodia, Vietnam, Brunei, Myanmar, Thailand, Indonesia, Philippines

▪️ 90Degrees Global (English) in Australia and New Zealand

▪️ Doers Group (Chinese) in Singapore, Malaysia, Thailand, Taiwan, China and Philippines

▪️ WHCreation.inc (Japanese) in Japan

▪️ And these organizations are given the right to market this Program in these countries/area.

Checkboxes *

I understand that any violation of the above agreements will result in legal proceedings, and I agree to honor the above agreements.

Signature *

Date *

Name *

First

Last