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Membership Form KLH 2025 v1
Please fill out and submit this form.
31
Questions
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1
Your Hiker name (= your name in Meetup)
*
This field is required.
Fill in the name you use for Meetup KL Hiking
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2
Your
FULL NAME
as on IC/Passport
*
This field is required.
You can omit A/P and A/L
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3
Gender
*
This field is required.
Female
Male
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4
Nationality
*
This field is required.
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5
Today's Date
-
Date
Day
Month
Year
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6
Date of Birth
*
This field is required.
-
Day
Month
Year
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7
Age
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8
E-mail
*
This field is required.
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9
Do you have a Malaysian mobile phone number?
*
This field is required.
YES
NO
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10
Select your provider.
*
This field is required.
Please Select
011
012-019
Please Select
Please Select
011
012-019
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11
Mobile phone number
*
This field is required.
Use only numbers
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12
Mobile phone number
*
This field is required.
Use only numbers
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13
Foreign mobile phone number
*
This field is required.
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14
Is your WhatsApp number the same as your mobile phone number...?
*
This field is required.
YES
NO
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15
WhatsApp Number
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16
IC No.
*
This field is required.
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17
Passport No.
*
This field is required.
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18
Does your MySejahtera app show that you are fully vaccinated against Covid-19?
*
This field is required.
YES
NO
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19
Do you have a medical condition of which we, as event organisers, should be informed? (eg. diabetes, allergies,...)
*
This field is required.
YES
NO
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20
If you have a medical condition, kindly specify
*
This field is required.
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21
Name of your emergency contact
*
This field is required.
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22
Relationship
*
This field is required.
Spouse
Partner
Parent
Child
Sibling
Relative
Friend
Colleague
Other
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23
Phone number of your emergency contact
*
This field is required.
Use only numbers
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24
Address 1
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25
Address 2
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26
Postal Code
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27
City/Township
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28
What is your own perceived hiking level?
*
This field is required.
Beginner
Less Experienced
Medium
Experienced
Very Experienced
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29
Are you an organiser, co-organiser or event host of another outdoor activities group...?
*
This field is required.
YES
NO
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30
If you know your Meetup link, paste the URL of your profile or replace the XXX with your profile number.
*
This field is required.
eg. https://www.meetup.com/KLhiking/members/280300686/
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31
Disclaimer/Terms and Conditions
*
This field is required.
I am attending the events/hikes/runs at my own risk. I understand that the organiser, co-organiser and/or event host will try their best to assist and guide, but are in no way responsible, liable or accountable for any loss, damage, personal injuries, death, etc. By clicking the Submit button I acknowledge that I have read, agreed and accepted the terms and conditions of the disclaimer. We use the same 128-bit encryption and physical security that banks use. Your information is all stored in encryption or hash. We do not use a SQL database, so there is no chance of SQL injection. Nobody can see your data through a DB console. Your private information will not be passed on to a third party for any purpose other than drafting participation lists, application of permits or in case of an emergency. However do note that some provided information, as there is your name, nationality, hiking level and attendance history are not considered confidential or sensitive in nature and might be casually or intentionally mentioned during conversations with other participants or involved parties unless you explicitly instruct us in writing not to do so.
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32
Signature
*
This field is required.
In the context of legal compliance, the Form provider requires that this form has be signed by you since we are collecting personal information.
Clear
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33
Initials
*
This field is required.
In the context of legal compliance, the Form provider requires that this form has be signed by you since we are collecting personal information. Your initials will suffice.
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34
Please verify that you are human
*
This field is required.
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