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MEMBERSHIP REGISTRATION FORM / Borang Pendaftaran Keahlian
Please complete the following form for record keeping purposes:
Sila lengkapkan borang berikut untuk tujuan simpanan rekod:
PESONAL DETAILS / Butiran Peribadi
NAME / Nama *
Your answer
IC NO. / No. KP *
Your answer
TITLE / Gelaran *
Required
DATE OF BIRTH / Tarikh Lahir *
MM
/
DD
/
YYYY
SEX / Jantina *
ETHNICITY / Etnik & Keturunan *
Required
CONTACT INFORMATION / Maklumat Perhubungan
MAILING ADDRESS / Alamat Surat-menyurat *
Your answer
CITY, STATE / Bandar, Negeri *
Your answer
POSTCODE / Poskod *
Your answer
HANDPHONE NO. / NO Tel. Bimbit *
Your answer
TEL. NO. / No. Tel. *
Your answer
E-MAIL / E-mel *
Your answer
EMERGENCY CONTACT PERSON / Perhubungan Semasa Kecemasan
NAME OF EMERGENCY CONTACT PERSON / Nama Individu Dihubungi Semasa Kecemasan *
Your answer
TEL. NO. / No. Tel. *
Your answer
RELATIONSHIP WITH EMERGENCY CONTACT PERSON / Hubungan dengan Individu *
MEMBERSHIP INFORMATION / Maklumat Keahlian
MEMBERSHIP STATUS / Status Keahlian *
MEMBERSHIP PROCESSING FEE / Yuran Pemprosesan Keahlian *
Required
FREE OHANA T-SHIRT / Percuma Baju T-Shirt OHANA (Include Postage)
SIZE CHART *
Captionless Image
Required
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