CAM

CHEVENING ALUMNI MALAYSIA (CAM) MEMBERSHIP APPLICATION FORM

Persatuan Alumni Chevening Malaysia
(reg. no. PPM-001-14-27041996)

* indicates required

Name: Email: Comment:

Email Address *

Title

Tan Sri/Datuk/Dato'/Dr./Mr./Ms.

Full Name as per MyKad *

MyKad Number

i.e. "900114-35-5176"

Current Profession and Workplace *

Year(s) of Scholarship i.e. 2017/2018 *

University *

Programme of Study *

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Contact Number (With Country Code) i.e.60123456789

Membership in Other Organisation (Name of Org.).

Position Held in the Organisation

Membership Fee *

Yes. CAM membership is a one-time life membership of RM100.00 only. Please make online payment to CIMB Bank Acct #8000550417 and notify us at cheveningalumnimalaysia.cam@gmail.com with bank transfer statement once you have made payment.

Consent *

I hereby give my permission for Chevening Alumni Malaysia (CAM) to share personal information with other organisations including but not limited to British High Commissioner, any affiliates and/or organisations related, whether directly or indirectly, with Chevening or any organisation in association with all or any or CAM activities, events and/or programmes. I understand that CAM may hold information gathered about me from the various organisation and as such my rights under the applicable Data Protection Act will not be affected. Your consent to share personal information is entirely voluntary and you may withdraw your consent at any time. Should you have any questions about this process or wish to withdraw your consent, please contact cheveningalumnimalaysia.cam@gmail.com.

Chevening Alumni Malaysia (CAM) New Member Registration Form