Kathina Trip to Dhamma Earth on 28 Oct 2019
All details must be completed in full and accurately. Acceptance is subject to receipt of payment and vacancy.
Please use a valid email address for the email response of the registration form to be sent to.
Email address *
Devotees joining the trip:
Members of family and friends are welcome to join.
Children/Dhamma School student must be accompanied by at least one parent or legal guardian.
1. Name (As per NRIC) *
of first participating devotee/parent/guardian
Your answer
1. NRIC *
Your answer
2. Name (As per NRIC)
of second participating devotee/parent/guardian.
Your answer
2. NRIC
of second participating devotee/parent/guardian.
Your answer
Children/Dhamma School student joining the trip
I, the first participating parent/guardian in the name above, will accompany my child/children in this event that requires transportation to a location away from the school site. As parent/guardian, I remain legally responsible for any personal actions taken by the above named minor participant. I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and defend Bandar Utama Buddhist Society, its officers, directors and agents, chaperons, or representatives associated with the event, from any and all actions, claims, demands, damages, costs, expenses and all consequential damage arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection associated with the event.
1. Child's Name (As per NRIC)
Your answer
1. NRIC
Your answer
2. Child's Name (As per NRIC)
Your answer
2. NRIC
Your answer
3. Child's Name (As per NRIC)
Your answer
3. NRIC
Your answer
4. Child's Name (As per NRIC)
Your answer
4. NRIC
Your answer
Contact details
Home Address *
Your answer
Mobile Phone *
of first participant.
Your answer
Terms and Conditions
Fees per person for Adults/Children is RM25.
Fees is inclusive of Transportation to & fro UBV and Dhamma Earth Club (DEC), and PA Insurance.

* All cheques for payment of participation fees / donations are to be made payable to "Bandar Utama Buddhist Society"
* Kindly print the response email of the registration form and submit with your payment to the Reception Counter/UBV office not later than 13 October 2019 as confirmation of participation.
* No cancellation or refund is allowed after the above deadline.
* Personal Data Protection Act 2010. By submitting this form, you consent to us processing and using your personal data in the manner as permitted by law and as stated in our Privacy Policy. An on-line copy of our latest Privacy Policy is located at https://bubs.my/privacy-policy.
Acknowledgement *
I acknowledge to the terms above.
Required
For inquiry, kindly contact
Sis. Lily at 012-278 8988
Sis. Poh Liew at 016-201 9268
For Official Use
Total no. of participants
Total Participation Fees (RM)
Fees per person for Adults/Children is RM25.
RM25
RM50
RM75
RM100
RM125
RM150
Total
Donations (RM)
Your answer
Total (RM)
Your answer
Receipt No.
Your answer
A copy of your responses will be emailed to the address you provided.
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