中文姓名:
Name in Mandarin:

英文姓名:
Name in English:

身份证号码:
Identity Card Number:

出生日期:
Date of Birth:

在校修业年份:
Period in School from:

至:
to:

职业:
Occupation:

办事处名称:
Company Name:

住址:
Mailing Address:

联络号码:
Contact Number:

电邮:
Email Address:

申请日期:
Date of Application:

请将此表格与入会费马币 RM20 一起提交:
Please submit this application form together with registration fee RM 20.00:

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余欲申请为贵会永久会员，余愿遵守会章及条例，余仅此声明以上所填各项属实.
I hereby apply for admission to be a life member of the Association. I agree to be bound by the Rules and Regulations of the Association. I hereby declare that the particulars given above by me are true and correct. (Must check this box to proceed)