ASSYAKIRIN MOSQUE MANAGEMENT BOARD

REGISTRATION FORM
3rd ISLAMIC CIVILISATION TOUR
9D/8N GUANGZHOU & KUNMING YUNNAN, CHINA
S$1,700 (FULL BOARD)

Please attach
recent
passport
photo

13th - 21st December 2011

Registration No.

FOR OFFICIAL USE:

PAID/ NOT PAID AMOUNT : $ _________________
*CASH/NETS/CHEQUE NUMBER: __________________
RECEIPT NO:________________ DATE: ________________
NAME OF ISSUING OFFICER: ________________________

Date:

ACCOMPANYING FAMILY MEMBERS : FATHER/MOTHER/ HUSBAND/WIFE/

DAUGHTER/SON/BROTHER/SISTER
Total No:

* please fill up a separate form for each participant

REQUIRED COPIES OF THE FOLLOWING DOCUMENTS:

NRIC/BC & PASSPORT
MEDICAL RECORDS/ PRESCRIPTIONS
PARENTAL/GUARDIAN LETTER OF CONSENT (FOR INDIVIDUALS BELOW 21)
DIETARY/ALLERY NOTIFICATIONS
VACCINATION: MENINGITIS / INFLUENZA

NAME (AS PRINTED IN PASSPORT):

ADDRESS: APT BLK

__________________________________

UNIT # _________________________

_______________________________________________________
OCCUPATION: ______________________________________

SINGAPORE ____________________
TEL:

( H ) ____________________

__________________________________________________

( O ) ____________________

EMAIL: ________________________________________

H / P ____________________

DATE OF BIRTH:
AGE:

NRIC NO. S

YEARS

PLACE OF BIRTH :

NATIONALITY:

INTERNATIONAL PASSPORT NO:

DATE & PLACE OF ISSUE
PASSPORT EXPIRY DATE
* IN CASE OF EMERGENCY, PLEASE CONTACT
NAME OF NEXT OF KIN

1)
2)

RELATIONSHIP

CONTACT NUMBER