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BORANG PENYERTAAN MAHABBAH CYCLING 2019
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Anjuran "MAHABBAH CYCLING 2019" adalah bertujuan mencari dana untuk rawatan pesakit dialisis. RM5 daripada yuran penyertaan akan disumbangkan kepada (Tabung Pusat Dialisis MAIS, Yayasan Islam Darul Ehsan) Yuran Penyertaan hendaklah dibuat atas akaun YAYASAN ISLAM DARUL EHSAN (AKAUN KORPORAT) BANK ISLAM MALAYSIA BERHAD - BIMB : 12234010007330
Para peserta diminta melengkapkan semua butir-butiran seperti berikut sebelum tarikh tutup penyertaan pada 4 Mac 2019 (Isnin).
Setiap penyertaan akan diberi t-shirt, medal dan 'goodies beg'.
BAJU MAHABBAH CYCLING
NAMA PENUH
*
Your answer
KAD PENGENALAN
*
MYKAD
PASPORT
NO. KAD PENGENALAN
*
Your answer
TARIKH LAHIR
*
MM
/
DD
/
YYYY
ALAMAT SEMASA
*
Your answer
NO. TELEFON
*
Your answer
EMEL
*
Your answer
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