TAMAN BUKIT JALIL RUNNING CLUB

Registration No. 3049/2009 www.huatuan.com/ab4/bukitjalil

MEMBERSHIP APPLICATION FORM

FULL NAME (BLOCK LETTER):

I/C NO:

SEX:

MALE

FEMALE

DATE OF BIRTH: AGE:

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-

TELEPHONE NO.:

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MAILING ADDRESS

POST CODE

NATIONALITY

EMAIL ADDRESS: __________________________________________________________

Occupation:

Name of Company:

__________________________ Date: _____________________

Applicant Signature

________________________________________________________________________

Recommend by

Committee Member Name : ______________ Signature: _______________

Date: _________________

Committee Member Name : ______________ Signature: _________________

Date: _________________

Approve by : ________________Signature ______________ Date: ___________

____________________________________________________________________________

For Official Use:

Name of Application: __________________ RM 10 Membership Entrance Fee paid on:

Membership No. : ________________ ______________ Receipt No. ___________

Expiry Date of Membership: _____________________

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