ALPHA REGISTRATION @ ASIAN BEACON

#TRYALPHA REGISTRATION FORM

Thursday Evening: 7:30 PM – 9:30 PM

Start Date: 17th May 2018

Asian Beacon 19-C, 3rd Floor, Jalan SS22/19, Damansara Jaya, 47400 Petaling Jaya, Selangor, Malaysia.

First Name

Last Name

Mobile Number

Age Group

Sex

Male Female

Address Line 1

Address Line 2

City

Postal Code

State

Dietary Requirements (Dinner will be provided)

We Are Here

Address: 689, Jalan Kuchai Lama, Taman Goodwood, 58200 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur