PRAISE LIFE COMMUNITY CHURCH (PLC)

赞美新生命教会
59-3, 3rd Flr, Jln Metro Perdana Barat 1, Taman Usahawan Kepong,
52100 Kuala Lumpur.

APPLICATION FORM

姓名 Name :

身份`证号码 IC No. :

性别 Gender :

地址 Address :

年龄 Age :

联络号码 Contact No. :

电邮 Email :

紧急联络 Emergency Contact

姓名 Name :
电话 Contact No. :

Please " X " on your application.

1. Skytrex Adventure Participant RM55.00

2. Non- Skytrex Adventure Participant RM15.00

Payment Method :
Kindly bank-in to
PRAISE LIFE COMMUNITY
Bank : Maybank Bhd
A/c No. : 514141-453043

Parent's Declaration for Participants below 18 years old

I, ________________________ hereby consent to participation by my child,___________________________,

in the event described above. I understand that as parent or legal guardian, i will remain fully responsible
for any legal responsibility which may result from any personal actions taken by my child
Parents signature
Maybank Bhd, PRAISE LIFE COMMUNITY, 514141-453043