GEGAR MEDIA CLUB REGISTRATION
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NAME AS ON YOUR IC * |
Please enter the name as registered in your identity card. |
PREFERED NAME TO BE PRINTED ON CARD |
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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 * |
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TYPE OF IC |
Old IC My Kad Passport |
IC NUMBER * |
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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.
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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 |
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