Jom Sertai "Walk for Humanity" 16 Mac 2014

Assalamualaikum, 

Ayuh berikan sokongan anda dengan menyertai Walk for Humanity. Sumbangan anda akan disalurkan kepada saudara-saudara di Syria, Palestin dan Rohingya. Maklumat Program :

Sila isikan borang online berikut untuk pendaftaran:

• Rose2Rose Walk For Humanity Registration Form

• Full Name*
• NRIC Number*
• Gender*
  Male Female
• Phone Number*
• Emergency Phone Number*
  Your family phone number if any emergency happens
• E-mail*
  So that we can get back to you
• Address*

  Street Address
  Street Address Line 2
  City	State / Province
  Postal / Zip Code	Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country

• T-shirt Size*
  Select your t-shirt size: M (40") L (42") XL (44") XXL (46") Wow! You will get this t-shirt for FREE!
• Payment can be made to:
  Maybank: Aqsa Syarif Berhad, 551575004299
  CIMB: Aqsa Syarif Berhad, 12160000452101
  
• Upload registration fee RM48.00 bank transfer receipt*
  Send Payment Receipt

  Your receipt in pdf, jpeg, png or any image file format

• My Rose2Rose Walk For Humanity Donation

• In full support of this charity event, I humbly pledge my donation of;
  In the name of humanity, this amount is an aid to Syria, Palestine and Rohingya people
• I understand that Rose2Rose Account Department will contact me for my donation confirmation
  Agree
• Should be Empty: