E-Registration Form IIUM PERSADA
IIUM PERSADA or Sekretariat Permuafakatan Siswa –Siswi Felda is a club established under Student Development Division (S-Dev) of International Islamic University Malaysia (IIUM). It aims to organize activities involving the generation of FELDA who are studying in IIUM. Besides, this club focuses on strengthening the ukhuwah between the members of the club and FELDA’s community throughout the country. We realize that it is the responsibility of the younger generation of FELDA to make a step in order to contribute more on the improvement of FELDA.
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FULL NAME *
NIRC *
E.g.: 891001-06-5159
DATE OF BIRTH *
E.g.: MM/DD/YYYY
MATRIC NO *
GENDER *
ADDRESS (FELDA) *
TOWN / CITY *
POSTCODE *
STATE *
TELEPHONE NO *
E.g.: 012-3456789
E-MAIL ADDRESS *
KULLIYYAH *
PROGRAMME / COURSE *
YEAR *
MAHALLAH *
BLOCK / ROOM NO *
E.g.: A 1.3
RELATIONSHIP WITH FELDA *
PLEASE LEAVE YOUR COMMENT/S OR SUGGESTION/S ABOUT IIUM PERSADA *
BUREAU OF INTEREST *
*Choose the most 5 bureaus you would like to join in IIUM PERSADA. Use no. 1 to indicate the most you prefer.
1
2
3
4
5
Discipline & Da'wah
Intellectual, Research & Information
Economy & Entrepreneurship
Sport, Culture & Recreation
Social, Welfare & Unity
I certify that the above information is true and correct *
Required
Attention:
1. IIUM PERSADA membership is exclusive to the new generation of FELDA at IIUM.
2. Please fill out this form completely by using ALL CAPITAL LETTERS. Incomplete applications will delay the approval process.
3. The submitted application will be processed and confirmation of registration will be notified via sms or e-mail.
4. If you have any problems and difficulties, please contact IIUM PERSADA by e-mail at iiumpersada2@gmail.com.
5. Please add us as your friend on facebook ''Iium Persada'' and ''IIUM PERSADA OFFICIAL GROUP ''.
6. You are also encouraged to access facebook ''Iium Persada'' because all information and activities will be informed there.
7. Your cooperation is highly appreciated. Thank you.
updated 15022012 version 2.4 created by: http://myartzdesign.blogspot.com

International Islamic University Malaysia
53100 Kuala Lumpur, Malaysia
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