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    06 Feb 2011 - PPKK Membership Form (English)

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    Tracy Gordon
    This document is a membership application form for the National Association of Special Education. It requests basic contact information such as name, date of birth, address, education background, and how the applicant can contribute. It lists different membership types with corresponding annual fees. Upon approval, it will provide a membership number. The applicant agrees to adhere to the association's regulations.

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    06 Feb 2011 - PPKK Membership Form (English)

    Uploaded by

    Tracy Gordon
    9 views1 page
    This document is a membership application form for the National Association of Special Education. It requests basic contact information such as name, date of birth, address, education background, and how the applicant can contribute. It lists different membership types with corresponding annual fees. Upon approval, it will provide a membership number. The applicant agrees to adhere to the association's regulations.

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    06 Feb 2011 - PPKK Membership Form (English) (1)

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    This document is a membership application form for the National Association of Special Education. It requests basic contact information such as name, date of birth, address, education background, and how the applicant can contribute. It lists different membership types with corresponding annual fees. Upon approval, it will provide a membership number. The applicant agrees to adhere to the association's regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views1 page

    06 Feb 2011 - PPKK Membership Form (English)

    Uploaded by

    Tracy Gordon
    This document is a membership application form for the National Association of Special Education. It requests basic contact information such as name, date of birth, address, education background, and how the applicant can contribute. It lists different membership types with corresponding annual fees. Upon approval, it will provide a membership number. The applicant agrees to adhere to the association's regulations.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    NATIONAL ASSOCIATION OF

    SPECIAL EDUCATION
    [ Regi s t r at i on Number : 2627- 09- WKL]

    Faculty of Education, University of Malaya,
    5 0 6 0 3 K u a l a L u m p u r , M a l a y s i a
    email: persatuan.pendidikankhas@gmail.com
    MEMBERSHIP APPLICATION FORM
    ____
    *
    Entrance fee (RM10/pay once only) _____ Associate (RM25/year) _____ Ordinary (RM50/year)
    ____ Institution (RM100/year) ____ Life (RM300/pay once only) ____ Honourary (Exempted for payment)
    * compulsory but pay once only
    Name (First): _______________________________ Name (Last): ___________________________
    Date of Birth: _______________ (dd/mm/yyyy) Gender:* Male / Female
    I/C No.: ____________________________ (new) Passport No.:
    Mailing Address:
    Permanent Address:
    Tel: ___________________ (House) _________________ (Office) ____________________ (Cell)
    E-mail: ________ __________________________ Fax: _________________________________
    Education Background: * Ph.D/ Masters/ Bachelor Degree / Diploma / Others: ________________
    Graduated from * University / College / School: __________________________________________
    I can contribute through: * Financial support, Short term project, Publication, Professional Expertise,
    Others (Please specify): [ ]
    * Choose whichever is relevant.
    I HEREBY CONFIRM TO ADHERE TO EVERY REGULATION AND RULE OF THIS ASSOCIATION IN THE EVENT
    OF THE APPROVAL OF MY MEMBERSHIP APPLICATION.
    FOR ASSOCI ATI ON USE ONLY
    Date received:
    Membership fee: RM _____ * (Cash/Cheque/Postal Order/Money Order)
    Receipt No.: _________ Bank Slip No.: __________ Membership No.: _______________
    Action: * Application approved / pending for approval / rejected
    Signature: _______________________ Name: _______________________ Date: ____________

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