UiTM HAB CREATIVE MEDIA & TECHNOLOGY PHOTOGRAPHY COMPETITION ENTRY FORM

PARTICIPANT INFORMATION

NAME MUHAMAD AZIZUL RAHIM BIN MUSA

AGE 35

IC NUMBER 800926-08-5729

HOME ADDRESS/

SCHOOL/UNIVERSITY/OFFICE

23,REGAT PEGOH 7,TMN PENGKALAN JAYA, PASIR PUTEH,31650 IPOH PERAK

TELEPHONE NUMBER MOBILE:019-4100350 OFFICE: 05-3135443E-MAIL Gejoey9445@gmail.com

PLEASE TICK CATEGORIES OPTION

SCHOOLCATEGORY

UNIVERSITYCATEGORY

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PICTURE TITTLE MENDIDIK GENERASI BERWAWASAN

LOCATION SK RAPAT SETIA ,IPOH

PICTURE DATE 19 /8 /2015

CAMERA MODEL & LENS D7000

PICTURE TITTLE RESPECT

LOCATION SK RAPAT JAYA

PICTURE DATE 19 / 8 / 2015

CAMERA MODEL & LENS D 7000

I hereby confirm that I agree and will comply with the competition conditions as stated. All photos submitted will become the property of the organizers and can be used without my permission.