Membership Registration Form

A. Personal Information

Full Name *

MyKad No. *

Date of Birth *

Gender *
MaleFemale

Marital Status *
SingleMarriedWidow

Own Transport *
YesNo

Occupation *

Company Name *

Company Address *

Mailing Address *

Contact No *

E-mail *

B. Emergency Contact

Name #1 *

Contact No #1 *

Relationship #1 *

Name #2 *

Contact No #2 *

Relationship #2 *

C. Involvement With Other NGO

(Please skip this section if this is your first registration in an NGO)

I am currently a member / I was a member of

E. Acknowledgement

1. I acknowledge that all the details and information provided in my application form are true, correct and complete.

2. I have never been involved in any criminal case.

3. I have never been involved in the distribution or abuse of drugs.

4. I agree to be bound by and comply with the rules and regulations of Persatuan Haiwan Terbiar Malaysia (SAFM)

By clicking here, you have read and agree to the terms and conditions agreement.