Liverpool Supporters Club Malaysia

Clubhouse Sri Permata Condo, Jalan Sultan Salahuddin Abdul Aziz Shah 9/6, Section 9, 40100 Shah Alam, Selangor Darul Ehsan, Malaysia (Managed by Liverpool F.C. Sdn. Bhd. 105230-V) Tel:603-58806069 Fax: 603-58809699 Website: www.lscm.com.my E-mail: enquiry@lscm.com.my

MEMBERSHIP APPLICATION AND RENEWAL FORM New Membership Full Name: Mr / Ms Membership no. Date

IC/ID no. Mailing Address 1 Mailing Address 2

Date of Birth
(DD/MM/YYYY)

State
Office or

Postcode Hand phone Email

Home Tel

Membership Type Subscription: 1 year Sabah & Sarawak Brunei Singapore

Adult
RM80 RM90 RM100 RM100

Below 18 Yrs
RM70 RM80 RM90 RM90 T-Shirt Size

XL

XXL

Postal Order, Bankers Draft & Cheque payable to Liverpool F.C. Sdn. Bhd Kindly include an additional of RM 0.50 for outstation cheques or Bank-in to our Maybank account no. : 512101-606024. Please fax us the bank-in slip after payment. (fax no.: 603-5880 9699) Do not pay to any unauthorized person. Terms & Conditions In these terms & conditions, the Club means the Liverpool Supporters Club Malaysia. The Club reserves the right to review the annual fee. The Club reserves the right to reject any application and no correspondence will be entertained. Membership Card is personal to a member and shall not be transferred under any circumstances. In the event lost or stolen, the member shall report this to the Club immediately. The Club reserves the right to suspend or withdraw the use of the relevant membership card in the event of misuse, abuse or in the event of a breach of any terms & conditions. The club reserves the right to suspend or expel any member who do not behave in orderly manner during club activities and are disruptive to other members. For more information, please visit our web-site at: www.lscm.com.my Membership Agreement: I have read and agreed the Terms & Conditions of Liverpool Supporter Club Malaysia.

Applicants Signature

Date

For Office Use Only

Date: Receipt no.: Mode of Payment: Cash / Bank Transfer / Cheque no.:_______________________________