KHHHKJ Membership Application Form

Name*

First NameLast Name

NRIC*

Please enter NRIC number

Birth Date

Date

Hand Phone No.*

Please enter a valid phone number.

Email*

example@example.com

Religion

TShirt Size*

Shoe Size*

EUR,

Marital Status*

SingleMarriedDivorcedWidower

Spouse Name*

Please type NIL if Not applicable

Wedding Date*

Date

Number of Children*

Home Address*

Street Address

Street Address Line 2

CityState

Post Code

Bank Details*

Bank NameAccount Number

Employer Name*

Employer Address*

Street Address

Street Address Line 2

CityState

Post Code

Occupation*

Hash Name if already exist, and other chapter names you are a member of.*

Hash Name or NILPrevious Chapter Names or NIL

Contact Person in case of Emergency (ICE)*

First NameLast Name

ICE Relationship*

ICE Hand Phone Number*

Please enter a valid phone number.

Allergies*

Please type NIL if none

Health Conditions*

Please type NIL if none

Are you an undischarged bankrupt?*

YESNO

Do you have any criminal record?*

YESNO

Recommended By*

Seconded By*

a) New Member application form is to be submitted after 3 successful runs.
b) Upon POB & Committee approval, entrance Fee: RM 90 x 3 Months (current month sub & 2 months deposit) = RM 270 + RM 50 (Registration ) = RM 320 is to be paid.
c) Applicant will be on probation for 90 days or untill he is baptised. If POB & Committee has no objections, applicant will be accepted as Harimau Member. Failing which the deposit of RM 180 minus any owing will be returned.
d) Member will abide by club rules and regulations. Be respectful and avoid vulgarity.
e) Member will agree that he will not hold Kelab Hash House Harimau Kelana Jaya responsible for any misfortunes or injuries or accidents
which he may suffer in the course of Hashing.
f) Member will hereby also undertake to pay all subscriptions and other club dues promptly.

Club Account Details
Bank : CIMB
A/C #: 8600438429
Name: Kelab Hash House Harimau Kelana Jaya

Once completed, please download the application form and send it to PGM Itchy Finger at 0123063994, together with a clear passport size photo of yourself.

Signature*