MALAYSIAN COUNCIL FOR REHABILITATION by cx89mEO

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									              MALAYSIAN COUNCIL FOR REHABILITATION
                      (Majlis Pemulihan Malaysia)
       RHYTHM DYNAMIC PROGRAM FOR MEMBERS AND ASSOCIATES OF
           MALAYSIAN COUNCIL FOR REHABILITATION AND NGO’S
__________________________________________________________________________________
                               REGISTRATION FORM

A.     The following are our participants to attend the Rhythm Dynamic Program :-

1.

2.

3.

4.

5.



B.     We are unable to send any participants



…………………………….
   (Signature)

Name of Officer       :      ____________________________________________________

Organisation Name     :      ____________________________________________________

Address               :      ____________________________________________________

                             ____________________________________________________

                             ____________________________________________________

Date                  :      __________________________

Organisation stamp    :

__________________________________________________________________________________

Please return the form before or on 7th April 2010 to:-

MAJLIS PEMULIHAN MALAYSIA
Malaysian Council for Rehabilitation
Room 3, 4th Floor, Bangunan Sultan Salahuddin Abdul Aziz Shah
No. 16, Lorong Utara ‘A’
46200 Petaling Jaya
Selangor
Tel. : 03-79553510         Fax : 03 – 7955 3514            e-mel : myrehab@tm.net.my

								
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