The Boys' Brigade in Malaysia - 18th Penang Company

War Museum Outing 2011

(For 18th Penang Company Members)

Please read the following instructions carefully.

1. Every member is required to complete a form each. Use BLOCK LETTERS.
2. There will be no refund unless with valid reason.
3. Members 18 years and below must complete the Parents/Guardians Consent Form overleaf.
4. The organising committee reserves the right to reject any application found not suitable and fee will be refunded in full.
5. All completed forms must reach the Registrar accordingly. Afterwhich no invalid requests will be entertained.

MEMBER'S DETAILS

NAME (as in NRIC)

BB COMPANY

RANK

NRIC NO. - - GENDER Male Female

DATE OF BIRTH BB AGE (as at 01.01.11) years

d d m m y y

TELEPHONE(H) MOBILE

Area Code

E-MAIL ADDRESS

Do you require any special medical attention? YES NO

If yes, give details below

ALLERGENS & SICKNESSES:

PROHIBITED FOOD & OTHERS:

FEES RM10 Pay on the spot when we go to War Museum

PARENT'S/GUARDIAN'S CONSENT

I hereby grant permission for my child/ward __________________________________________________ to participate in t

War Museum Outing 2011 that will be held at War Museum Penang which falls on 25th of June 2011 (Sunday) from 8.00am
12.00pm.

I undertake not to hold The 18th Penang Company, its officials, organisers or assigns liable for any claims or loss arising as
result of any untoward incidents during the entire event.

Signature of Parent/Guardian d d m m y

Name :
Relationship :
NRIC No. :
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