Associate Member of Olympic Council of Malaysia

MALAYSIAN DANCESPORT BERHAD (276051-H)

Application for Membership Membership Particulars (please complete this Section in full)
*to be completed by applicants

Name: Correspondance Address:

*Gender Telephone: Facsimile: Mobile No: Email:

Male

Female

Home Address: /Registered Office: Day *Occupation: NRIC/Passport or Business Registration No. Nationality: *Have you competed in the professional category before?
compete

Incorporation Date /Birthday

Month

Year

Yes

No Yes

If yes, when did you last

*Are you a dance instructor or proprietor of any dance studio or school? If yes, please provide name of the studio
Notes : (Please read the notes carefully before signing this application) 1.

No

All applications must be signed and accompanied by payment of:RM100/- per individual Ordinary Member RM200/- per Ordinary Corporate Member as a non refundable donation. Please draw up cheques payable to Malaysian Dancesport Berhad. DO NOT ENCLOSE CASH. This is only an application for membership and each application is subject to the approval of and acceptance of the Council. The Council reserves the right to reject any application without ascribing any reason thereto. Where applications are rejected, payments will be refunded accordingly to the applicant. One application form must be submitted for each applicant. No joint application will be accepted. In signing this application form, the applicant agrees to comply with all rules, regulations and directions of Malaysian Dancesport Berhad.

2.

3. 4.

.................................................................. Signature
Note : Membership categories Membership in the Association shall be divided into:1) 2) Ordinary Member An individual person

.................................................................. Date

Corporate Member A corporation, organization or institution that is incorporated or registered under the laws of Malaysia.

For Office Use Only Application Accepted Membership Supporting Council Yes Ordinary No Corporate Date Accepted Honorary

Signature

Name

Signature

Name

Correspondence Address : Mailbox 27, Room 5, 1st Floor, Wisma OCM, Jalan Hang Jebat, 50150 Kuala Lumpur (Fax: +603 27152836)