BARKADA KONTRA DROGA FORM NUMBER:

Membership Form DATE:

Please fill out the form truthfully

1X1 ID PICTURE

LAST NAME FIRST NAME MIDDLE NAME

DATE OF BIRTH (DD/MM/YYYY) PLACE OF BIRTH (OPTIONAL) GENDER

RESIDENTIAL ADDRESS STATE

MOBILE PHONE

FACEBOOK NAME SCHOOL

SCHOOL ADDRESS YEAR LEVEL SECTION

WHAT SKILL/TALENT DO YOU BELIEVE YOU HAVE THAT WILL BENEFIT THE CLUB?

WHY DO YOU WANT TO JOIN?

I HEREBY AGREE TO THE PRESENT AND FUTURE TERMS & CONDITIONS OF BKD

NAME SIGNATURE