Register Form – Persatuan Luncur Udara Malaysia

Registration Form:

You be attending?

Name *

First

Last

Email *

Phone Number/Whatsapp

Nationality

ID/ Passort Number

Date of Birth

Type of Blood

CIVL/ National Ranking

Current Rating

Sponsor

GLIDER: Manufacture

Model, Size & Max Weight

Certification

HARNESS: Brand & Model.

Birth IN Passort

Reserve Last Checked Date

IN CASE OF EMERGENCY TO CONTACT: Name

Relation & Phone Number

Terbang House, Lot 69A, Batu 27, Jalan Morib, Banting Selangor | Phone: +6013-370 3331 | Email: malaysiaparaglidingteam@gmail.com