REGISTRATION FORM

2013

BORANG PENDAFTARAN

REGISTRATION FORM

RETURN THIS FORM + RM 25 FEE BY 21 JULY 2013/

KEMBALIKAN BORANG INI + YURAN RM 25 SEBELUM
21 JULAI 2013

2013

BORANG PENDAFTARAN

PERSONAL DETAILS / MAKLUMAT PERIBADI

PERSONAL DETAILS / MAKLUMAT PERIBADI

Gender/
Nama penuh: ___________________________________________________________ Jantina:
Full Name/
Category/
Categori:

Address/
Alamat:
Parish/
Paroki:
I.C. No./
No. KP:
H/P No.:
Allergies/
Allergi:

Secondary school/
Sekolah menengah

Working
_
Adult/
Bekerja

College/Uni
____________

Age:
Other/
lain

___________________________________________________________
___________________________________________________________

__________

(must be more
than 13 yrs old on
1 August 2013/
mesti berumur 13
tahun ke atas pada
1 Ogos 2013)

Group/

Please fill either parish or

youth group only/ tolong
isikan Paroki atau
___________________________________________________________ kumpulan sahaja.

___________________________________________________________ Kumpulan: ___________________________________________________________

Tel No.

_____________________________ (Home/Rumah):

____________________________

__________________________ E-mail/ E-mel:

____________________________

or/atau (Office/Pejabat)

(if Yes, please indicate. / Jika Ya, sila nyatakan)

Gender/

Full Name/
Category/

Categori:

Address/
Alamat:
Parish/
Paroki:
I.C. No./
No. KP:
H/P No.:
Allergies/
Allergi:

Secondary school/
Sekolah menengah

or/atau

Working
_
Adult/
Bekerja

College/Uni
____________

Other/
lain

___________________________________________________________
___________________________________________________________

__________

(must be more
than 13 yrs old on
1 August 2013/
mesti berumur 13
tahun ke atas pada
1 Ogos 2013)

Group/

Please fill either parish or

youth group only/ tolong
isikan Paroki atau
___________________________________________________________ kumpulan sahaja.

___________________________________________________________ Kumpulan: ___________________________________________________________

Tel No.

_____________________________ (Home/Rumah):

____________________________

__________________________ E-mail/ E-mel:

____________________________

or/atau (Office/Pejabat)

(if Yes, please indicate. / Jika Ya, sila nyatakan)

ACCOMMODATION / PUSAT PENGINAPAN

Yes/Ya

Age:

Nama penuh: ___________________________________________________________ Jantina:

ACCOMMODATION / PUSAT PENGINAPAN

Do you require accommodation?/Adakah anda memerlukan tempat penginapan?

Host Centre or/atau

RETURN THIS FORM + RM 25 FEE BY 21 JULY 2013/

KEMBALIKAN BORANG INI + YURAN RM 25 SEBELUM
21 JULAI 2013

Do you require accommodation?/Adakah anda memerlukan tempat penginapan?

No/Tidak

Yes/Ya

Host Family (if Yes please indicate 1 only/ jika Ya sila pilih 1 sahaja)

Host Centre or/atau

or/atau

No/Tidak
Host Family (if Yes please indicate 1 only/ jika Ya sila pilih 1 sahaja)

For those opting to stay with a Host Family, you are encourage to follow the organising committee's decision. / Bagi mereka
yang akan menginap dengan Host Family, digalakkan untuk mematuhi keputusan pihak penganjur.

For those opting to stay with a Host Family, you are encourage to follow the organising committee's decision. / Bagi mereka
yang akan menginap dengan Host Family, digalakkan untuk mematuhi keputusan pihak penganjur.

OFFICE USE ONLY / UNTUK KEGUNAAN PEJABAT SAHAJA

OFFICE USE ONLY / UNTUK KEGUNAAN PEJABAT SAHAJA

AMOUNT
RECEIVED:

RM ______________________

PAYMENT
RECEIVED BY:

DATE:

_________________________

INITIAL &
STAMP:

_________________________

SERIAL. NO.

AMOUNT
RECEIVED:

RM ______________________

PAYMENT
RECEIVED BY:

DATE:

_________________________

INITIAL &
STAMP:

_________________________

SERIAL. NO.
_________________________

_________________________

-------------------------------------------------------cut here/ leraikan disini------------------------------------------------

-------------------------------------------------------cut here/ leraikan disini------------------------------------------------

PLEASE KEEP THIS PORTION AS PROOF OF PAYMENT

MENT
/ SILA SIMPAN HELAIAN INI SEBAGAI BUKTI BAYARAN

PLEASE KEEP THIS PORTION AS PROOF OF PAYMENT

MENT
/ SILA SIMPAN HELAIAN INI SEBAGAI BUKTI BAYARAN

NAME: ___________________________________________________________________________

NAME: ___________________________________________________________________________

AMOUNT
RECEIVED:

RM ______________________

PAYMENT
RECEIVED BY:

AMOUNT
RECEIVED:

RM ______________________

PAYMENT
RECEIVED BY:

DATE:

_________________________

INITIAL &
STAMP*:

DATE:

_________________________

INITIAL &
STAMP*:

_________________________

SERIAL. NO.

_________________________

SERIAL. NO.
_________________________

*PROOF OF PAYMENT VALID ONLY WITH OFFICIAL STAMP/ BUKTI BAYARAN HANYA SAH DENGAN COP RASMI

_________________________
*PROOF OF PAYMENT VALID ONLY WITH OFFICIAL STAMP/ BUKTI BAYARAN HANYA SAH DENGAN COP RASMI