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MEMBERSHIP

GEGAR MEDIA CLUB REGISTRATION



NAME AS ON YOUR IC *

Please enter the name as registered in your identity card.
PREFERED NAME TO BE PRINTED ON CARD

ADDRESS


Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Please enter valid postal address for postage services.

UPLOAD YOUR PHOTO

Upload your photo for membership card.

EMAIL *

Please enter your valid email address
Confirm Your Email Address EMAIL *

TYPE OF IC
 Old IC 
 My Kad 
 Passport 
IC NUMBER *

PHONE NUMBER *

Please enter your valid telephone number.
TYPE OF MEMBERSHIP *

Please select the member's category preferred.
Payment shall be made within 14 days form the date of form submission to:

Gegar Media Channel
Account MAYBANK #123456789012.

Please indicate GEGARIANS on payment remark. Text "YOUR IC NO, AMOUNT and DATE" to +60199853770 upon completion of transaction.
ALERT ME ON GEGAR ENVENTS AND PROMOTIONS *
 Yes 
 No 
I HAVE READ AND AGREE WITH THE TERM OF MEMBERSHIP SERVICE *
 Yes, I agree. 


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