PERSATUAN WARISAN TAIPING, PERAK
(TAIPING HERITAGE SOCIETY, PERAK)
BORANG PERMOHONAN MENJADI AHLI / MEMBERSHIP APPLICATION FORM
NAMA PEMOHON SEPERTI DALAM KP / NAME AS IN I.C.
NO KP / I.C. NO
TARIKH LAHIR / BIRTH DATE
TEMPAT LAHIR / PLACE OF BIRTH
PEKERJAAN / OCCUPATION
ALAMAT / ADDRESS
TEL / HP NO
EMEL / EMAIL
example@example.com
SAYA INGIN MEMOHON UNTUK MENJADI / I wish to join as -
AHLI BIASA / Ordinary member
AHLI SEUMUR HIDUP / Life member
AHLI ASSOCIATE / Associate member
AHLI SEUMUR HIDUP ASSOCIATE / Associate Life member
AHLI KORPORAT / Corporate member
Tandatangan / Signature
Tarikh / Date:
Nama Ahli Pencadang / Proposer name
Nama Ahli Penyokong / Seconder name
Preview PDF
Continue
Continue
Should be Empty: