BORANG PENDAFTARAN KEAHLIAN

NO. AHLI :.....

2012

KELAB ANAK-ANAK
BERSELAWAT
SILA TAMPAL
GAMBAR
ANDA DI SINI

MAKLUMAT PERIBADI

Nama

:...............................................................................

No. KP/Sijil Kelahiran :.................................................................................

Alamat Rumah

: ................................
.............................................................................

Bandar
No. Tel Rumah
No. Tel. Bimbit
E-mel

: Negeri :..
: .....................................
:..............
:............................................

Nama & Alamat

Sekolah : ...............................................................................................................
.....................................................................................
.............................
.....................................................................................
.............................
Jantina

Nama
Ibu/Bapa/Penjaga

: Lelaki

Perempuan

: ...........................................................................................

No.Tel Ibu/Bapa/Penjaga : .................................................

BORANG PENDAFTARAN KEAHLIAN

NO. AHLI :.....

Tandatangan: ...........................................
Tarikh: ...................

2012