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ASIAN LAW STUDENTS ASSOCIATION

MALAYSIA CHAPTER
REGISTRATION FORM

TYPE OF MEMBERSHIP: ORDINARY / AFFILIATED*

APPLICANT DETAILS
1. Name: ___________________________________________________________________
2. Identification Card / Passport No: _____________________________________________
3. Nationality: _____________________________ 4. Religion: ______________________
5. Race (Malaysian Only): ___________________

6. Gender: M / F *

7. Address: _________________________________________________________________
___________________________________________________________________________
8. Contact No: Mobile: ________________________ Home: __________________________
9. Tertiary Institution: ________________________________________________________
10. Student ID : ________________________ 11. E-mail: ___________________________
By signing this form, hereby I declare that all the information stated above are all correct and any false
information will result termination of my membership in ALSA Malaysia according to the ALSA Malaysia
constitution and agree to be bound by all rules and regulations that has been implemented within this society
(ALSA Malaysia).

Signature: _____________________________
(
)

Seconded by: ______________________

(
)

Date:

Date:

*ENTRANCE FEES: RM5 (ONE

TIME FEE)

FOR OFFICE PURPOSE ONLY

1. Application is ACCEPTED / REJECTED *
Reason(s) if REJECTED: _________________________________________________________
2. Membership No. : _________________________________________________________________

Authorised by,

Confirmed by,

ALSA Stamp;

_______________________
Secretary General
ALSA Malaysia

____________________
Treasurer
ALSA Malaysia

Date:

* Strikethrough any irrelevant section.