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 |
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. |
Image Verification |
 |
|
|
|
0 comments:
Post a Comment