Membership Application Form

MACMA SELANGOR MEMBERSHIP APPLICATION FORM
Malaysian Chinese Muslim Association Selangor Branch
No.77-3A-1 (4th Floor) Jalan Metro Perdana Barat 1
Taman Usahawan, Kepong Utara
52100 Kuala Lumpur
*Required
NRIC No. *
Your answer
Foreign Nationality
Your answer
Name *
Your answer
Age
Your answer
Gender
Date Of Birth *
DD
/
MM
/
YYYY
Year Embraced Islam
Your answer
Marital Status
Clear selection
Home Phone
Your answer
Mobile Number *
Your answer
Email
Your answer
Profession
Your answer
Address
Your answer
City
Your answer
State *
Choose
Selangor
Negeri Sembilan
Melaka
Perak
Pahang
Johor
Terengganu
Kelantan
Kedah
Pulau Pinang
Perlis
Sabah
Sarawak
WP Labuan
WP Kuala Lumpur
WP Putrajaya
Emergency Contact Person
Name
Your answer
Emergency Contact *
Mobile Number
Your answer
Education Level
Clear selection
Communication Language
Recommended By
Your answer
Membership Category *
Ordinary Membership is opened to born and converted Chinese Muslims. Associate Membership is opened to Non-Chinese Muslims.
Required
Membership Term
With effect from January 2014, all membership fees will resume as below. For membership application received, paid and renewed within the term 2012-2013, status will remain as at point of application. To check status of membership term, kindly refer to sister Alina Ong.
Note Remarks
Your answer
Membership Fees & Activation
Membership Activation is upon receipt payment of membership fees. Membership Fees is RM20. Currently we only accept cash or bank transfers payment. Please make all payments to account : 'Bank Islam 1209-2010-0307-22' to Persatuan Cina Muslim Malaysia Cawangan Selangor (MACMA). Email or fax a copy of your bank-in slip or transactions to alinaong8687@gmail.com.

Upon activation of your membership, you will receive notification and invites to MACMA Selangor's activities and events. Please do update us if there are changes to your membership details by sending an email with the subject 'UPDATE' to sister Alina as above email address.
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