Contribution Form for Dhuha Talk

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CONTRIBUTION FORM FOR DHUHA TALK BY SYEIKH YAHYA IBRAHIM
SEPT 29, 2013
FLAMINGO HOTEL, AMPANG KUALA LUMPUR

A. TABLE FOR 10 PAX

DINNER TABLE FOR 10 PAX *

A RM 10,000.00

B RM 7,000.00

C RM 5,000.00

D RM 3,000.00

E RM 1,500.00 (RM 1,200.00 - Before 31st Aug 2013)

F RM 150.00 (Loose Seat)

No of Tables

No of seat (for loose seat)

Amount (RM) *

B. SPONSORSHIP / DONATION

SPONSORSHIP / DONATION (Please tick)

Sponsor table for Non Muslims/Converts/Orphans

Cash donation

Clear selection

No of Tables

Amount (RM)

C. SPONSOR'S PARTICULARS AND DETAILS OF PAYMENT

Name *

Name of company / organisation

Company No

Address *

(Line 1)

Address

(Line 2)

City *

Postcode *

State *

Tel No *

Fax No

Email *

Contact Person

Designation

Type of payment

Cheque

Cash

Bank in/online transfer

Clear selection

Cheque No

(If paid by cheque)

Bank

Amount (RM)

D. TAX EXEMPTION

Please tick the box below if you need tax exemption *

Yes

All cheques should be crossed and made payable to
'YAYASAN PENDIDIKAN KHALIFAH'
BANK ISLAM : 12122010012401

ADDRESS
Yayasan Pendidikan Khalifah, 427 Jalan 2, Taman Ampang Utama, 68000 Ampang, Selangor

EMAIL
khalifahfoundation.edu@gmail.com

ENQUIRIES
En Aimi Aizal: 012 3267472, Pn Rosnani: 012 6186033, Pn Sharifah: 019 3437622
Office: 03 42566810 / 013 2849555
Fax: 03 42565423

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