For Parents Bahagian A (Maklumat Ibu Bapa / Parent Particulars)Nama Ibu (Mother’s Name) No. Telefon Ibu (Mother’s Phone Number) Emel Ibu (Mother’s Email Address) Nama Bapa (Father’s Name) No. Telefon Bapa (Father’s Phone Number) Emel Bapa (Father’s Email Address) Address (Alamat) City State Postcode Balik (Previous)Seterusnya (Next)Bahagian B (Maklumat Bayi / Baby’s Particulars)Name (Nama) Jantina (Gender) Lelaki (Male)Perempuan (Female)Tarikh Lahir (Date of Birth) Tempat Lahir (Place of Birth) Hubungan dengan Bayi (Relationship to Baby) Tandakan Jenis Klef (Types of Cleft) Klef Bibir Sahaja (Cleft Lip Only)Klef Lelangit Sahaja (Cleft Palate Only)Klef Bibir & Lelangit (Cleft Lip and Palate)Anomali Kraniofasial (Craniofacial Anomoly) Sebelah (Unilateral) Dua Belah (Bilateral)Jenis (Type) Balik (Previous)Seterusnya (Next)Bahagian C (Jenis Keahlian / Membership Type) Saya setuju menjadi ahli CLAPAM dan akan mematuhi syarat-syarat perlembagaan. Bersama borang ini saya sertakan slip “Bank-In” sebagai yuran keahlian saya. I agree to be a member of CLAPAM and abide by its Constitution. I attached herewith, my membership fee. Sila pilih tempoh keahlian (Please choose a membership type)RM 10.00 – Yuran Ahli Tahunan (Annual Membership)RM 100.00 – Yuran Ahli Seumur Hidup (Lifetime Membership)Derma – Sila nyatakan jumlah (Please state amount)Bank in ke akaun CLAPAM : Maybank 014301107258Sila WhatsApp gambar resit bank in ke: +60122283677 atau muat naik di bawah Please Bank into CLAPAM’s Bank Account : Maybank 014301107258Please send the receipt via WhatsApp to: +60122283677 or upload it belowMuat Naik Resit (Transfer Slip Upload) Choose File Balik (Previous) Hantar (Submit) For Professionals Bahagian A (Maklumat Anda / Your Particulars)Nama Anda (Your Name) No. Telefon Anda (Your Phone Number) Emel Anda (Your Email Address) Address (Alamat) City State Postcode Balik (Previous)Seterusnya (Next)Bahagian B (Maklumat Kerja / Work Particulars)Tempat Kerja (Current Workplace) Pekerjaan (Your Occupation) Bidang Anda, Kalau anda ialah Ahli Perubatan (Your Specialty, if you are a Medical Personnel) Balik (Previous)Seterusnya (Next)Bahagian C (Jenis Keahlian / Membership Type) Saya setuju menjadi ahli CLAPAM dan akan mematuhi syarat-syarat perlembagaan. Bersama borang ini saya sertakan slip “Bank-In” sebagai yuran keahlian saya. I agree to be a member of CLAPAM and abide by its Constitution. I attached herewith, my membership fee. Sila pilih tempoh keahlian (Please choose a membership type)RM 10.00 – Yuran Ahli Tahunan (Annual Membership)RM 100.00 – Yuran Ahli Seumur Hidup (Lifetime Membership)Derma – Sila nyatakan jumlah (Please state amount)Bank in ke akaun CLAPAM : Maybank 014301107258Sila WhatsApp gambar resit bank in ke: +60122283677 atau muat naik di bawah Please Bank into CLAPAM’s Bank Account : Maybank 014301107258Please send the receipt via WhatsApp to: +60122283677 or upload it belowMuat Naik Resit (Transfer Slip Upload) Choose File Balik (Previous) Hantar (Submit)
