Registration Form

Title : *

Name : *

D.O.B:*

day

month

year

Affiliation :*

Address:*

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

Mobile Phone:*

Area Code

Phone Number

E-mail:*

Academic Level:*

University :*

Others : Please state

Graduation / Expected Graduation Year:*

Area of Specialization :*

Please tick on the provided space *

I declare all the information provided is true.

I agree to become a member of Kyoto Malaysia Alumni Association (MYKYOTO)

As a member of Kyoto Alumni Association Malaysia (MYKYOTO), I agree to pay:*

Lifetime membership fee RM280 and registration fee of RM20.00 (Total RM300.00)

One year membership fee RM30 and registration fee of RM20.00 (Total RM50.00)

Associate membership (Registration fee of RM20.00 ONLY)

Please make payment to :

Account Name : Persatuan Alumni Kyoto Malaysia

Account No : 5622 6352 2566

Bank Name : Maybank

(Please email your proof of payment to kyotoalumni@gmail.com)