PARTICIPANTS’ PERSONAL DATA

Name as per MyKad:                                                                

Christian Name:                                                                        
Sex:                             £ Male       £ Female  (Please tick)
Mykad No:                                                                               
Credential Status:          £CW    £EX    £LC     £OR   £ BELIEVER    
Name of Church:                                                                      
Contact No:                                                       (O)                                          (H/P)

SPOUSE’S DATA: (Fill in only if he/she is coming)
Name as per MyKad:                                                                

Christian Name:                                                                        
Sex:                             £ Male       £ Female  (Please tick)
Mykad No:                                                                               
Credential Status:           £CW    £EX    £LC     £OR   £ BELIEVER   
Contact No:                                                       (O)                                          (H/P)

CHILDREN’S DATA (Fill in only if he/she is coming)
Y= Youth 13 years and above
C= Child  6 to 12 yrs old
O= Other,  5 yrs old & below

No	Name	(M/F)	Date of Birth / MyKad	Age	(Y/C/O)

FOR OFFICE USE:
Adults:                                                             
Cash/Cheque/MO/PO#:                         
Youths (Above 13):                                          
Amount in RM                                       
Children (From 6 to 12):                         
Date of registration:                               
Other (5 & below):                                         
Receipt No:                                          

TOTAL PAX:                                                        
Issued by/on: