3 Days 2 Nights Pulai Desaru Beach, Malaysia

1
Love Story
I am my lovers my lover is mine...
3 Days / 2 Nights _at_ Pulai Desaru Beach,
Malaysia 30 May 1 June 2008
REGISTRATION / INDEMNITY FORM
Name of Husband (passport name)
_____________________________________________ NRI
C________________ Nationality ________________
Date of Birth _______________ Passport
No._________________ Date of Issue/Expiry_______
________/_______________ Home Address___________
__________________________________________________
___ Telephone _______________(H)
____________________(O) _____________________(HP)
Email _________________________________________
_____________________________ Occupation
_________________ Educational Level
______________ Religion _________
Name of Wife (passport name) ____________________
____________________________ NRIC_______________
_ Nationality ________________ Date of Birth
_______________ Passport No._________________
Date of Issue/Expiry_______________/_____________
__ Home Address_________________________________
_______________________________ Telephone
_______________(H) ____________________(O)
_____________________(HP) Email
__________________________________________________
____________________ Occupation
__________________ Educational Level
______________ Religion ________

• Date of Marriage (ROM) ______day ______month
  ______year
• 
  
• I, _______________________________
  NRIC______________ do hereby delcare that my wife
  and I
• participate in the above retreat on our own
  accord and that we shall not hold the organiser
  or the staff
• responsible for any losses or injuries which may
  be sustained by us arising from the above
  retreat.
• Signature of husband _________________________ Da
  te _____________________
• Terms Conditions for all participants
• A 40 levy will be imposed for any cancellation
  made before 12 May 2008. No refund is allowed
  for cancellation made after 12 May 2008.
• All valid International passports must have at
  least 6 months validity from the actual date of
  departure.
• Kindly made cheque payable to REACH Community
  Services Society

For official use Payment received on
__________________________ Amount
________________ Cheque No.______________________
_____________ Bank __________________ Handle
d by _____________________________
Receipt No. ______________
Blk 187 Bishan St 13 01-475 S(570187) Tel 6
252 2566 Fax [phone]