PCM MEMBERSHIP REGISTRATION All fields are required
	(APPRECIATE ALL IN CAP / HURUF BESAR)
NAME:
NICKNAME/NAMA SAMARAN:
GANDER/JANTINA:
NRIC NO:	999999-99-9999
DATE OF BIRTH:
CELEBRATE:	HARI RAYA CHINESE NY DEEPAVALI X'MAS OTHERS
H/PHONE NO:	60191234567
EMAIL ADDRESS:	myemail@yhoo.com
OCCUPATION/PEKERJAAN:
EMPLOYER/MAJIKAN:
ADDRESS:	LOT 43492, JALAN KLINIK
LOCATION/TAMAN:	BUKIT NAGA
POST CODE, TOWN/BANDAR:	40460 SHAH ALAM
STATE/NEGERI:	SELANGOR
CAR PLATE NO:
MODEL:	405SRI / 407DLX / 308TURBO / 206BES
TRANSMISSION:	AUTO MANUAL
YEAR MODEL/TAHUN DAFTAR:
COLOUR:
INS.CO/SYKT INSURAN:
PREFERRED ACTIVITIES:	1.TT SESSION 2.DIY SESSION 3.SHOP VISIT 4.SUNDAY DRIVE 5.CONVOY 6.TRACK DAY 7.CHARITY
WISH TO PARTICIPATE IN ORGANISING?:	YES NO
KNOW PCM VIA:	INTERNET FRIENDS CAR STIKER CLUB ACTIVITIES MEDIA
WHAT PCM CAN DO: APA PCM BOLEH BUAT:
THANK YOU AND WELCOME TO PCM COMMUNITY!... Please SMS "payment date, amount & car no" to 019-2257589 for acknowledgement. Membership fee: Registration fee RM30.00 (one time) Annual fee only RM20.00 Total: RM50.00 Club Acct Maybank: 5143 0132 0153 Maybank2U: 1142 6301 3754 (Paramjit Singh - PCM Treasurer)
By submitting this APPLICATION, I declare that all information provided are true and complete to the best of my knowledge and belief. Should I be accepted, I agree to abide by the rules and regulations of Peugeot Club Malaysia.