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  • ASCW Mbrship Appn Form

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    Suni Tamin
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    This document is a membership application form for a nutrition program initiated by the Pediatric Association of Malaysia. The summary is: 1. The membership is free and provides free magazines, seminar registrations, nutritional information and gift redemption rewards. 2. Applicants provide their personal details and details of up to 3 children under age 10, including name, date of birth, gender, race and current milk brand used. 3. Applicants mail the completed form along with an Abbott product scoop handle to the listed address to complete the simple 3 step application process.

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    This document is a membership application form for a nutrition program initiated by the Pediatric Association of Malaysia. The summary is: 1. The membership is free and provides free magazines, seminar registrations, nutritional information and gift redemption rewards. 2. Applicants provide their personal details and details of up to 3 children under age 10, including name, date of birth, gender, race and current milk brand used. 3. Applicants mail the completed form along with an Abbott product scoop handle to the listed address to complete the simple 3 step application process.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    14 views1 page

    ASCW Mbrship Appn Form

    Uploaded by

    Suni Tamin
    This document is a membership application form for a nutrition program initiated by the Pediatric Association of Malaysia. The summary is: 1. The membership is free and provides free magazines, seminar registrations, nutritional information and gift redemption rewards. 2. Applicants provide their personal details and details of up to 3 children under age 10, including name, date of birth, gender, race and current milk brand used. 3. Applicants mail the completed form along with an Abbott product scoop handle to the listed address to complete the simple 3 step application process.

    Copyright:

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    of 1

    Membership Application Form

    Borang Permohonan Ahli


    You will enjoy...
    Membership is
    Keahlian adalah

    FREE!

    PERCUMA

    & advice/Positive Parenting magazine* FREE nutritional informationPediatric Association initiated by Malaysia FREE registration for seminars/activities on nutrition GIFT redemption rewards

    Only 3 simple steps to join!

    Members Particulars /
    FULL NAME (AS PER IC) /

    / Butir-butir Ahli:
    / NAMA PENUH (SEPERTI DALAM K/P):

    *Children Particulars (only applicable to children between 1-10 years old)


    Butir-butir Kanak-kanak (hanya untuk kanak-kanak dari umur 1-10 tahun)
    CHILDS NAME / CHILDS GENDER / / JANTINA ANAK:

    / NAMA ANAK:
    DATE OF BIRTH / / TARIKH LAHIR:
    DD MM YY

    GENDER / NEW NRIC /

    / JANTINA:

    F/

    / P:

    M/

    / L:

    F/

    /P

    M/

    /L

    / NO K/P BARU:

    CURRENT MILK BRAND USED / JENAMA SUSU YANG DIGUNAKAN SEKARANG: CHILDS NAME /

    / NAMA ANAK:
    DATE OF BIRTH / / TARIKH LAHIR:
    DD MM YY

    DATE OF BIRTH / / TARIKH LAHIR: RACE /


    MALAY / / MELAYU ENGLISH / B. INGGERIS

    DD

    MM

    YY

    CHILDS GENDER / / JANTINA ANAK:


    F/ /P M/ /L OTHERS / / LAIN-LAIN

    / BANGSA:

    CHINESE / / CINA CHINESE / B. CINA

    INDIAN / / INDIA

    CURRENT MILK BRAND USED / JENAMA SUSU YANG DIGUNAKAN SEKARANG: CHILDS NAME / CHILDS GENDER / / JANTINA ANAK:
    F/ /P M/ /L

    LANGUAGE PREFERRED /

    / BAHASA PILIHAN:
    MALAY / B. MALAYSIA /

    / NAMA ANAK:
    DATE OF BIRTH / / TARIKH LAHIR:
    DD MM YY

    PREFERRED CHANNEL OF COMMUNICATION / CARA PERHUBUNGAN DENGAN ANDA:


    EMAIL / EMAIL / / EMEL / EMEL: MAIL / / SURAT TELEPHONE / / TELEFON

    CURRENT MILK BRAND USED / JENAMA SUSU YANG DIGUNAKAN SEKARANG:


    Please mail this form to : : Sila poskan borang ini ke :

    TELEPHONE NO. /
    HSE / OFF / / RUMAH: / PEJABAT:

    / NO. TELEFON:

    / H/P / TELEFON BIMBIT:

    Abbott Share & Care World PO Box 7662 Pejabat Pos Besar 40670 Shah Alam Selangor DE Malaysia

    Ab bo tt Sh Pe PO are jab Se 4067 at Box & Ca lan 0 Po 76 re go Sh s 62 W or r DE ah Be ld Al sa Mala am r ys ia

    Complete this form

    Attach an Abbott product scoop handle

    Mail them to us

    ADDRESS (PO BOX NOT ALLOWED) / ALAMAT (PETI SURAT TIDAK DIBENARKAN):

    By returning this form, you agree to be contacted by our Abbott sta .


    Note: Kindly allow 4-6 weeks for activation of membership / / Nota: Sila tunggu 4-6 minggu untuk pengaktifan keahlian anda.

    POSTCODE / / POSKOD:

    STATE / / NEGERI:

    Toll Free 1800 88 6233 (Mon-Fri, 9am-6pm) www.abbott.com.my

    CSC09

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