PRINTABLE MEMBERSHIP FORM

Dear Sir / Madam,

         Pemalik invites members who share our Aims and Objectives
I, the undersigned, hereby apply to be a member of the above-mentioned Association.
I agree, if admitted, to be bound by the Rules & Constitution of the Association. (Refer to Perlembagaan)
Name in Full
(BLOCK LETTERS)
IC No    Age       Sex: Male / Female    
Nationality    Marital Status   
House Address
House Telephone    Email    
Occupation / Profession   Company Telephone   
Company Name and Address
Reason for Joining
Date   Signature of Applicant   
Entrance Fee RM10 Life Member RM200 Ordinary Member RM20 Yearly Associate Member RM20 Yearly
All cheques must be made payable to "Pertubuhan Mencegah Alienasi Keibubapaan Kuala Lumpur dan Selangor or "PEMALIK"
PLEASE PRINT AND POST YOUR APPLICATION WITH YOUR CHEQUE AS OUR ABOVE ADDRESS

FOR OFFICE USE ONLY

Membership Number: _________________________  Official Receipt Number:______________________


Approved By:_______________________________  Date:_______________________________________


Proposed By:______________________________  Seconded By:_________________________________


Signature:________________________________  Singnature:__________________________________


Name:___________________________________  Name:______________________________________


Date:____________________________________  Date:_______________________________________