Registration Form

Rose2Rose Walk For Humanity Registration Form
Full Name*
NRIC Number*
Gender*

MaleFemale
Phone Number*
Emergency Phone Number*
Your family phone number if any emergency happens
E-mail*
So that we can get back to you
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
T-shirt Size*
Wow! You will get this t-shirt for FREE!
Payment can be made to:

Maybank: Aqsa Syarif Berhad, 551575004299

CIMB: Aqsa Syarif Berhad, 12160000452101
Upload registration fee RM48.00 bank transfer receipt*

Send Payment Receipt
Your receipt in pdf, jpeg, png or any image file format Cancelof
My Rose2Rose Walk For Humanity Donation
In full support of this charity event, I humbly pledge my donation of;
In the name of humanity, this amount is an aid to Syria, Palestine and Rohingya people
I understand that Rose2Rose Account Department will contact me for my donation confirmation

Agree
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Rose2Rose Walk For Humanity Registration Form