Membership

Application - Information

Name:
Sex:	Male Female
Address:
Telephone:
Mobile:
Email:
Nationality:
Occupation:
Interests:

Spouse/Partner - Information

Name:
Telephone:
Mobile:
Email:
Nationality:
Occupation:
Interests:

Children - Information

Name	Date of Birth	M/F

Membership - Information

MABL 2013 Annual Subscription Rates

Student: €18
Individual: €28
Family: €38

Membership Subscription Type:

Payment by:

If paying by Bank Transfer, please write

“ MEMBERSHIP – THE YEAR – YOUR NAME ”

Allow personal data to be published on Members Directory
Yes
No

Malaysian Association of Belgium and Luxembourg