This document is a registration form for a 2-part funeral management course being held on October 26-27, 2013 from 8am to 5pm at the Masjid Tuanku Mizan Zainal Abidin in Putrajaya, Malaysia. The form requests the participant's name, identity card number, address, phone numbers, email, signature, and date to register for the program.

1. MASJID TUANKU MIZAN ZAINAL ABIDIN
JABATAN KEMAJUAN ISLAM MALAYSIA
PRESINT 3,63500 PUTRAJAYA
Tel :03-8880 4300 Fax : 03-8890 1614
LAMAN WEB : www.masjidtuankumizan.gov.my
EMEL : admin@masjidtuankumizan.gov.my
BORANG PENDAFTARAN
PROGRAM/KURSUS/SEMINAR : KURSUS PENGURUSAN JENAZAH SIRI 2
TARIKH : 26 -27 OKTOBER 2013 (SABTU – AHAD)
MASA : 8.00 PAGI – 5.00 PETANG
Nama
No.Kad Pengenalan
Alamat/Jabatan/Agensi : ______________________________________________________
______________________________________________________
______________________________________________________
No. Tel : _____________________(P) ____________________(H/P)
E-mail : ______________________________________________________
Tandatangan Tarikh :
…………………………………………
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