1. SCOUTS MOVEMENT,
SEKOLAH MENENGAH KEBANGSAAN DATUK HAJI AHMAD SAID,
13800 BUTTERWORTH, PULAU PINANG.
_____________________________________________________________________
Scouts Movement Membership Form
Section A: Personal Details
1. Name :Azman Bin Mohammad
2. Form :1 Amanah
3. I/C No. :9000903-10-6019
4. Age :13
5.Date of birth :03 September 1990
6.Address :21 Jalan Besar,Klang,Selangor
7. Parent’s Name :Mohammad Bin Basri
8. Telephone No. :03-332722159
Section B : Co-curricular Activities
Other society / club joined;
* Society :Bahasa Melayu
*Club :Hand Ball
*_______________________________________________________________________
I hereby that particulars given above are true and I will abide by the
Scouts rules if I am accepted to be a member.
Signature:………………………………………………………………….

2. Date:………………………………………………………………………..
SCOUTS MOVEMENT,
SEKOLAH MENENGAH KEBANGSAAN DATUK HAJI AHMAD SAID,
13800 BUTTERWORTH, PULAU PINANG.
_____________________________________________________________________
Scouts Movement Membership Form
Section A: Personal Details
1. Name :
2. Form :
3. I/C No. :
4. Age :
5.Date of birth :
6.Address :
7. Parent’s Name :
8. Telephone No. :
Section B : Co-curricular Activities
Other society / club joined;
* Society :
*Club :
*_______________________________________________________________________
I hereby that particulars given above are true and I will abide by the
Scouts rules if I am accepted to be a member.
Signature:………………………………………………………………….

3. Date:………………………………………………………………………..
SCOUTS MOVEMENT,
SEKOLAH MENENGAH KEBANGSAAN DATUK HAJI AHMAD SAID,
13800 BUTTERWORTH, PULAU PINANG.
_____________________________________________________________________
Scouts Movement Membership Form
Section A: Personal Details
1. Name :
2. Form :
3. I/C No. :
4. Age :
5.Date of birth :
6.Address :
7. Parent’s Name :
8. Telephone No. :
Section B : Co-curricular Activities
Other society / club joined;
* Society :
*Club :
*_______________________________________________________________________
I hereby that particulars given above are true and I will abide by the
Scouts rules if I am accepted to be a member.
Signature:………………………………………………………………….

4. Date:………………………………………………………………………..