Registration Form

 

Own a Porsche? Then join the club by filling up this simple form:

 

Personal Information

 

Full Name

Full Name :: as in NRIC/Passport

 

Nationality

 

NRIC/Passport Number

 

Date of Birth

Date of Birth :: dd/mm/yyyy

 

Place of Birth

 

Address (Residence)

 

Postcode

 

State

 

Business Information

 

Company Name

 

Address (Business)

 

Postcode

 

State

 

Position in Company

 

Name of Secretary

 

Contact Information

 

Telephone numbers

 

Business

 

Facsimile

 

Residence

 

Mobile

 

Email

 

Preferred correspondence Address

Business
Residence

 

Car Information

 

Car 1

 

Car Model

 

Model Year

 

Registration No.

 

Colour

 

Car 2

 

Car Model

 

Model Year

 

Registration No.

 

Colour

 

Car 3

 

Car Model

 

Model Year

 

Registration No.

 

Colour

 

Non-refundable Fees

 

Joining Fee: RM 500
Annual Fee: RM 200

 

I will be sending a cheque of RM

 

Cheque No.

 

Please make crossed cheque payable to "Porsche Club Malaysia" and send to

 

PORSCHE CLUB MALAYSIA
c/o Porsche Centre
PNB Darby Park Retail
10 Jalan Binjai
50450 Kuala Lumpur

 

Please provide 2 copies of photographs for membership card.

 

I declare that all information provided is 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 the club.

 

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