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Membership Application
MAHIMA REGISTRATION FORM
PIC Name
*
Temple Name
*
Registration Type
*
-- Select --
Life Member
Ordinary Member
Temple Registration Number
*
Temple Registration Date
If Not Registered, Year Commenced
Land Type
-- Select --
Own Land
TOL
Rental
No Title
Private Owner
Others
Others Detail
TOL State
Phone Number
*
Country
*
State
*
-- Select State--
Johor
Kedah
Kelantan
Labuan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Sabah
Sarawak
Selangor
Terengganu
Wilayah Persekutuan
City
*
Post Code
Email ID
Bank Account Number
*
Bank Name
*
Submit