Member Application Form

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Member Application Form

Type of Membership

Ordinary Life Membership - RM 300 + RM10 Entrance FeeOrdinary Member - RM30 a year + RM10 Entrance FeeAssociate Life Member - RM 300 + RM10 Entrance FeeAssociate Member - RM30 a year + RM10 Entrance Fee

Personal Data

Name (required):

Address:

Contact No (House):

Contact No (Mobile):

Email:

Gender: MaleFemale

Date of Birth:

NRIC No(New):

Place of Birth:

Marital Status:

No. of Children:

Occupation Data

Company:

Contact No. (Office):

Type of Business:

Occupation:

Your Boys' Brigade Involvement

Previous BB Company:

Last rank held:

Years of Involvement:

Joined BB in Year:

Are you still serving in any BB company? YesNo

If YES, which BB company are you serving now?

What rank are you now?

Attach a copy of your photo here

I hereby declare that the above information are correct and will abide by the Constitution if Persatuan Stedfast Kuala Lumpur. I enclose herewith an attachment of the donation that I have made.

Kindly make your payment to PERSATUAN STEDFAST KUALA LUMPUR. Maybank Account No: 0-14039-32705-4

Once done, you may attach the receipt below.