Raleigh KL E-Membership Form
Hello and welcome to Raleigh KL's E- Membership Form.

Raleigh KL will be using these information to update our membership database. By registering with us, we are able to keep you in the loop with our activities.You know you miss mama Nature and papa Adventure!

If you'd like to renew your membership, please email Secretary2@raleighinternational.org.my with your name and details of your expiry date of your membership.

For more inquiries on Raleigh KL and this form, please email info@raleighinternational.org.my. New membership will be RM30 and subsequent yearly renewal will be RM20.

If you have stumbled upon this site then it may not have been a coincidence. Find out more about us and what we do at www.raleighinternational.org.my

1) My name is
As according to your I.C./ Passport
Your answer
2) But you can call me
Tim? Thomas? Maggie?
Your answer
3) Gender
4) I.C./ Passport Number
Ex: XXXXXX-XX-XXXX
Your answer
5) You can call me at
601XXXXXXXX
Your answer
6) Email
Your answer
7) I joined Raleigh Kuala Lumpur back in
Ex: 1995/ Newcomers can write current year
Your answer
8) Date of Birth
DD/MM/YYYY
Your answer
9) Mailing Address
Include Postcode as well
Your answer
10) My profession is
Required
11) Company/ Institute
Name of Company or Institute of Learning
Your answer
12) My means of transport is
Required
13) Apart from eating and sleeping, I am also good in
Required
14) Have you been to our Monthly Activity (also known as Monthly Meet)? If yes, when was the last time?
E.g. July 2015
Your answer
15) Have you been to our Introduction Weekend ?If yes, please state Month and Year of I.W. If no, please state no.
E.g. I.W. Dec 2012 or No
Your answer
16) Have you been on any Raleigh International Expeditions or any expedition organised by Raleigh International Support Groups? If yes, please state Country, Season and Expedition Code. If no, please state no.
E.g. Borneo Autumn 12K or No
Your answer
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