Scuba Registration Form ( Perhentian Island, Malaysia )

MASTER SHOT EVENT MANAGEMENT (001517155-P)

REGISTRATION FORM 4D 3N 'PADI' Basic Open Water Diving Course:

26 – 30th APRIL 2009 @ Perhentian Island! MALAYSIA

Name

:

___________________________________________________

IC / Passport :

___________________________________________________

Address

___________________________________________________

:

_____________________________________________________________________ __________________________ Postcode

:

___________________________

Tel

:

____________________ (Mob)

__________________(Hse)

Email

:

__________________________________________________

Position

:

__________________________________________________

------------------------------------------------------------------------------------------------------In case of emergency please call: Name

:

_____________________________________________

Tel

:

_____________________________________________

------------------------------------------------------------------------------------------------------All of the information stated is true and I agreed that organiser shall not be liable on any personal negligence that caused property loss or life during this programme.

------------------------Date

--------------------------------------Sign by

©MASTER SHOT EVENT MANAGEMENT [email protected] 012 3133224 ( If no answer, PLEASE sms )

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MASTER SHOT EVENT MANAGEMENT (001517155-P)

_________________________________________________ IMPORTANT Form must be submitted by email TO: [email protected] [email protected] Signed form must be present on departure to Shahriza Mahmud. ( Please print a copy ) Please bank in a reservation fee of RM400 TO: Maybank current account of ; MASTER SHOT EVENT MANAGEMENT Account Number: 5122 04 808 639 Email the receipt to: [email protected] [email protected] TEL: 012 3133224 ( If no answer, PLEASE sms ) PS: FOR DETAILS OF THE EVENT PLEASE CHECK IT OUT HERE: http://www.facebook.com/event.php?eid=84112937968

©MASTER SHOT EVENT MANAGEMENT [email protected] 012 3133224 ( If no answer, PLEASE sms )

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