Raising Young Khalifah IV | 8 March 2014

Name*

First NameLast Name

Birth Date*

MonthDayYear

Organisation

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

Submission Date*

MonthDayYear

Participation*

Berpasangan - Suami Isteri (RM350)Berkumpulan 6 (5 Bayar, 1 Percuma) - RM950Alumni RYI I (13 Nov 2012) RM150Alumni RYK II (1 May 2013) RM150Alumni RYK III (10 Nov 2013) RM150Individual (Normal Rate ) RM190

Participant Name(s) & Email(s):*

Example : Ali Bin Din / ali@email.com

Age of Children(s)*

How did you know about this event?*

School name** *

Please state as some % from our sales will be donated to schools that have been supporting us. TQ

----------------------------------------------------------------------------------------------------------

Kindly transfer payment to LANIKA VENTURES , Maybank , Account Number : 562674210876

Kindly make cheque payable to LANIKA VENTURES

(Please send us proof of payment to info@raisingyoungkhalifah.com)

IMPORTANT

For payment made via Maybank2u, please type in YOUR NAME in the TRANSACTION

DESCRIPTION and NOTIFY us by including this phone number ( +6011 3910 2268) or

Raising Young Khalifah's email ( info@raisingyoungkhalifah.com ) when making the

payment for us to track your transaction.

Failure to do so will result your registration NOT to be processed.

THANK YOU