P.O.

Box 60260,91112 Lahad Datu, Sabah

11th JCIM ACADEMY 2008

11th - 14th October 2008
Hosted by JCI Lahad Datu

REGISTRATION FORM

Name : Name to Appear on Badge:

Current Position : Date of Birth:
Mailing Address:
City: Postal Code:
State: Country:
Home Telephone: Home Fax:
Office Telephone: Office Fax:
Hand Phone: E-mail Address:
Profession/Occupation: Languages Spoken:
Chapter:
T-shirt Size: S [ ]M[ ]L[ ] XL [ ] XXL [ ] XXXL [ ]
Registration Details Flight Detail
Registration fees - RM 400.00 Arriving Date:
Registration fees includes: Flight No:
1. T-shirt 2. breakfast 3. lunch 4. tea breaks and 3-nightsETA:
accommodation and stationery.
Payment Details Approved by Chapter President
Registration fees : RM ________________
Bank-in to Lahad Datu Junior Chamber
A/C No: 3089745126, Public Bank Bhd.
For Further Details & enquiries, Please Contact: _______________________________________
JC Vanessah Ramlee (President) - 0135416903 Signature of Chapter President
0168289088 Name:
JC Lim Yit Joon (Advisor) - 0128137101 Date:
JC Ng Fui Yin (Reg.in Charge) - 0138931113 I hereby understood and agreed the terms &
Address: Lahad Datu Junior Chamber conditions of 11th JCI Malaysia Academy 2008,
P.O.Box 60260, 91112 Lahad Datu, Sabah.
Fax No: 089-883661
E-mail: hui_yin79@yahoo.com
_______________________________________
Signature of Participant
Name:
Date:
DEAD LINE FOR REGISTRATION ON 12TH SEPTEMBER 2008