Borang

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BORANG PENYERTAAN KL MOOT 2009 KREW DAERAH/ZON NEGERI ALAMAT

: ………………………….. : ………………………….. : ………………………….. : …………………………..

………………………... ………………………... PEMIMPIN KREW KELANA BIL

NAMA PENUH (HURUF BESAR)

NO. KPT

JANTINA

NO. TELEFON

NO. KPT

JANTINA

NO. TELEFON

01 02 AHLI-AHLI PENGAKAP KELANA BIL

NAMA PENUH (HURUF BESAR)

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 JUMLAH PENYERTAAN

: …………… ORANG x RM 80 = RM …………..

PENGESAHAN PEMIMPIN KREW KELANA,

………………………………….. ( ) TARIKH:

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