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Yayasan Anak Warisan Alam (406702-M)

Founded 1990

(Children's Environmental Heritage Foundation)
Suite H-2-20 Block H,
Jalan 1A/3, Taipan Damansara 2, Ara Damansara,
47301 Petaling Jaya,
Selangor, Malaysia.
Tel: 03-7842 6782; Fax: 7842 6749

E-mail: info@yawa.org

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Become a member PDF Print E-mail
Written by Administrator   
Saturday, 27 February 2010 23:18

become a member

You may choose one of these YAWA programmes:

Junior Environmental Group of Malaysia. Age 6 - 14.
Eco-Youth Challenge and Adventure. Age 14 and above.

  APPLICATION FORM





A. Applicant Details
YAWA Programme to choose: JEGOM EYCA
Family Name
First Name
Gender Male Female
Age
Date of Birth Pick a date
Birth Certificate No. (Under 12)
IC No.
Passport No.
Postal Address
Telephone
Fax
E-mail



B. Languages
Understood
1.
2.
3.
 

Spoken
1.
2.
3.




C. Special Needs
Do you have any speical needs? Yes No
Mobility (eg: wheelchair user?)
Hearing/Speech (please specify)
Special Diet (please specify)
Others (please specify)



D. Parent/Guardian Details
Father's Name
Tel/Fax
Address

Mother's Name
Tel/Fax (Leave blank if same with father's)
Address (Leave blank if same with father's)

Guardian's Name
Tel/Fax
Address



E. Project - Do you have a project report you wish to share with YAWA?
Your project will be published in YAWA's newsletter/activity page
Project Title/Name
Website URL (if any)
Project Details



F. Organisation/School Details
Name, Address and Country of Organisation/School

Tel -
Fax -



G. Registration Fees
RM 50 For every new membership
RM 5 Annual subscription

You will also recieve:
  • Free quarterly newsletter - 'YAWA Update'
  • A YAWA Badge
  • Special rates of all YAWA activities and merchandise


    • Your membership fees will be collected during your first activity.
    H. Consent Form
    Consent form must be filled in for all members under the age of 18.
    Forms are available from the secretary

    You may also download and print the form. Post your consent from to the address below:
    Secretary,
    Yayasan Anak Warisan Alam,
    No. 16, Lorong Rahim Kajai 13,
    Taman Tun Dr. Ismail,
    60000 KUALA LUMPUR, Malaysia.
     Tel: 03-7727 5592
    Fax: 03-7727 5592

    Click here to download the form in MS-Word format.
    I. Declaration
    I hereby confirm that the information recorded in this form is true.
    Please enter the string shown in the image in the form.
    The possible characters are letters from A to Z in capitalized form and the numbers from 0 to 9
     
    All character is in Big / Capital Letter
     
    Last Updated on Sunday, 28 February 2010 01:05