REGISTRATION FORM

PERSONAL DETAILS

Name

I/C Number Age

Gender Male | Female

Occupation

Institution /
Workplace

Experience in the
Performing Arts

CONTACT DETAILS

Mobile Number House Number

E-mail

Mailing Address
PARENT’S CONSENT (Members below the age of 18)

I, _________________ (parent/guardian) of
_______________, provide him/her the permission to participate in
the activities organized by the Green Leaf Theatre House.

______________
Name :
I/C No. :

APPROVAL FROM ACADEMIC INSTITUTION (Students)

Disclaimer

I, __________________ the_______________ (Director/

Principal/ Vice Principal/ Chancellor) of _______________
(Institution), provides the above student with the permission to
participate in the activities organized by the Green Leaf Theatre
House.

______________
Name :
I/C No. :

DISCLAIMER

It is hereby acknowledged that all the details provided above are correct and
legitimate. I understand and agree that I would need to submit an annual
membership fee of RM50 in order to be a registered member of the Green Leaf
Theatre House. The Green Leaf Theatre House will not be responsible for any
casualties that I may face whenever I participate in its activities howsoever caused.

______________
Name :
I/C No. :
Date :
FOR OFFICE USE

The above applicant has fulfilled the all the requirements in order to be a registered
member of the Green Leaf Theatre House and will immediately be entitled to the
privileges of a registered member.

______________

Name :
Post :
Date :

ACCEPTANCE OF MEMBERSHIP SUBJECT

TO THE COMMITTEE’S APPROVAL.

Approved/Not Approved: …………………

Date of Approval: ………………………….

Membership No: …………………………..

Membership Fees Paid/Unpaid: ………...........

Receipt No: …………………………