Gambar

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PERSATUAN ALUMNI UNIVERSITI UTARA MALAYSIA

372, Taman Teja, Lebuhraya Changloon-Bukit Kayu Hitam,

06010 Changloon, Kedah Darul Aman
Tel : 604-9242780 Email : alumniuumassociation@gmail.com

BORANG PENDAFTARAN KEAHLIAN

MEMBERSHIP FORM
Nama

No. Matrik

Name

Matric No.

No k/p :

Bangsa

Passport No.

Race

Alamat Tetap :

Poskod

Permenant Address

Postcode

.........................................................................................................

: ....................
: .....................
:..

.........................................................................................................
Emel

Email

No. Tel

:...

Telephone No.

Tahun Konvokesyen
Year Of Convocation

Facebook

Program: ..
Programme
Butiran Pekerjaan/ Occupational Details

1. Nama Syarikat : ...........................................................................................

Company Name

2. Alamat

: ...........................................................................................

Company Address

3. Jawatan

: ..........................................................................................

Job Title

4. No. Tel (P)

: ........................................

No. Faks

: .......................................

Phone (O)
Fax
_____________________________________________________________________________________________________
1.
2.

Borang ini hendaklah dilengkapkan oleh semua graduan yang akan berkonvokesyen dan dihantar ke kaunter HEA pada
hari pengambilan jubah.
This form must be completed by all graduates and submitted to HEA counter during collection of robe.
Kegagalan menghantar borang ini menyebabkan graduan akan dihalang daripada mengambil jubah.
Failure to submitted this form will barred graduates from taking your robe.

Tandatangan/Signature

.....................................................................

Tarikh/Date

...................................