PRINTABLE MEMBERSHIP FORM

                                                       Dear Sir/Madam,
 
                                                       Pemalik invites those who share our Aims and Objectives to become our members.
 
    
Name in Full
(BLOCK LETTERS)
IC No
Address    
Telephone    Email    
 

Reason for Joining PEMALIK

 

   I, the undersigned hereby apply to become a member of the above mentioned Association.

  I, agree, to be bound by the Rules and Constitution of the Association

Date                                             Signature of Applicant
                

                   

 

    Entrance Fee RM 10/=                      Ordinary Member RM 20/=   Yearly

    Life Member RM 200/=                     Associate Member RM 20/=  Yearly

 

 

All cheques must be crossed and made payable to : "PEMALIK" or

" Pertubuhan Memupuk Asas Ikatan Keluarga Kuala Lumpur dan Selangor "

Please submit your application with payment to the above address
________________________________________________________________________________________

FOR OFFICE USE ONLY

Membership Number: _________________________  Official Receipt Number:______________________


Approved By:_______________________________  Date:_______________________________________

Proposed By:______________________________  Seconded By:_________________________________