Imam An-Nawawi – Appreciating Allah’s Blessings Of Time And Age (Khutbah 17 Jun_2011)
University of the Third Age, KL & Selangor · PDF fileUniversity of the Third Age, KL &...
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Transcript of University of the Third Age, KL & Selangor · PDF fileUniversity of the Third Age, KL &...
University of the Third Age, KL & Selangor
MEMBERSHIP REGISTRATION FORM . Borang Pendaftaran Keahlian
Please complete the following for record-keeping purposes:
Sila lengkapkan butiran berkenaan untuk simpanan rekod:
1. Personal Details . Butiran Peribadi
Name . Nama
IC No. . No. K/P
Title . Gelaran Tun / Tan Sri / Pn. Sri / Dato’ / Datin / Prof. / Dr. / Mr. / Mrs. / Ms.
Date of Birth . Tarikh lahir
Sex . Jantina Male . Lelaki Female . Perempuan
Ethnicity . Keturunan Malay . Melayu
Chinese . Cina
Indian . India
Other Bumiputera . Bumiputera Lain
Others . Lain-lain
Education . Pendidikan No formal education Tiada pendidikan formal
Primary education Pendidikan sekolah rendah
Secondary education Pendidikan sekolah menengah
Tertiary education Pendidikan kolej / universiti
2. Contact Information . Maklumat Perhubungan
Mailing Address . Alamat Surat-menyurat
City / State . Bdr./ Negeri Postcode . Poskod
Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel.
Fax No. . No. Faks E-mail . E-mel
3. Emergency Contact Number . Nombor Hubungan Kecemasan
Name . Nama
Relationship . Hubungan
Hp. No. . No. Tel. Bimbit Tel. No. . No. Tel.
4. Association’s Corresponding Address . Alamat Surat-menyurat Persatuan
Tel. : 603-89472755 / 2741 . Fax : 603-89472744 / 2738 . E-mail: [email protected]
K L & S E L A N G O R
Association for Lifelong Learning of Older Persons (U3A) Kuala Lumpur and Selangor
Persatuan Pembelajaran Sepanjang Hayat Warga Emas (U3A) Kuala Lumpur dan Selangor c/o Institute of Gerontology . Institut Gerontologi Universiti Putra Malaysia 43400 UPM Serdang, Selangor, Malaysia
5. Payment Instructions . Arahan Pembayaran Please forward the form with payment, a photocopy of your identity card and two (2) passport-sized photos to U3A Kuala Lumpur & Selangor.
Sila hantar borang ini berserta bayaran, salinan kad pengenalan dan dua (2) keping gambar bersaiz pasport kepada U3A Kuala Lumpur & Selangor.
All banker’s order / banker’s cheque should be made payable to “U3A KL & Selangor”.
Segala bayaran cek harus dibuat di atas nama “U3A KL & Selangor”.
FOR OFFICE USE . Untuk Kegunaan Pejabat
Membership No. No. Keahlian
Payment Details Butiran Pembayaran
, , ,
, , ,
Member Category & Fees Kategori Ahli & Yuran
Ordinary Member . Ahli Biasa (55+) [RM25 per year . setahun]
Life Member . Ahli Seumur Hidup (55+) [RM150 one-time payment . sekali seumur hidup]
Associate Member . Ahli Bersekutu (50-54) [RM25 per year . setahun]
Note: A one-time member registration fee of RM10 is applicable for new members only.
Nota: Yuran pendaftaran / masuk sebanyak RM10 dikenakan sekali ke atas ahli-ahli baru sahaja.
U3AKLSelangor/MemberF/290311/v.1.01/CST