UiTM HAB CREATIVE MEDIA & TECHNOLOGY

PHOTOGRAPHY COMPETITION ENTRY FORM

PARTICIPANT INFORMATION
NAME
MUHAMAD AZIZUL RAHIM BIN MUSA
AGE
35
IC NUMBER
800926-08-5729
HOME ADDRESS/
23,REGAT PEGOH 7,TMN PENGKALAN JAYA,
PASIR PUTEH,31650 IPOH PERAK
SCHOOL/UNIVERSITY/
OFFICE
TELEPHONE NUMBER
E-MAIL

MOBILE:019OFFICE: 054100350
3135443
Gejoey9445@gmail.com

PLEASE TICK CATEGORIES OPTION

SCHOOL
CATEGORY
PICTURE TITTLE
LOCATION
PICTURE DATE
CAMERA MODEL &

UNIVERSIT
Y
CATEGORY

PROFESSIO
NAL
CATEGORY

MENDIDIK GENERASI BERWAWASAN

SK RAPAT SETIA ,IPOH
19 /8 /2015
D7000

LENS
PICTURE TITTLE
LOCATION
PICTURE DATE
CAMERA MODEL &

RESPECT
SK RAPAT JAYA
19 / 8 / 2015
D 7000

LENS
I hereby confirm that I agree and will comply with the competition
conditions as stated. All photos submitted will become the property
of the organizers and can be used without my permission.