Download - MHCUC Registration Form 2015
BORANG PERMOHONAN AHLI BIASA
UMPIRES REGISTRATION FORM(Please attach 2 passport size coloured photo)
UMPIRES PERSONAL DETAILS
1. Name in Full :ALVIN ADATHANAK
JUA
2. Identity Card No : 920419-13-5855
3. Age: 23 Years old
4. Occupation: STUDENT
5. Mailing Address:
(latest)RUMAH NUING, SUNGAI MAPAI
Post Code:96700State:SARAWAK
6. Email Add: [email protected]
7. Contact No:0135679125
Tick (( ) in appropriate column:Umpire Status :FIHPULGred 1World Cup / Olimpic
(at present)Class 1Class 2Class 3 Year passed Theory Exam:2014
I would like to be involved inOutdoor Hockey /Indoor Hockey
/ Both Category I, hereby agree that all information given is true. I am aware that MHCUC has the right to reject my application at any time should it be found any false details have been given. ( ................................................................) Date:.....................22.06.2014................................
Umpires Signature
ENDORSED BY STATE UMPIRES BOARD APPROVED BY MHC UMPIRES COMMITTEE
( ................................................................) ( .....................................................................)
Chairman of State Umpires Board Chairman of MHC Umpires Committee
Date : Date :Tarikh:
STATE ASSOCIATION
STAMP
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