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IC/BC/Passport No DOB

MSN Perak “ Merdeka ” Junior Tennis Championships 2014. Entry Form. ENTRY INFORMATION. Tournament Title. MSN PERAK MERDEKA CLOSED JUNIOR TENNIS CHAMPIONSHIPS 2014. Tournament Dates Entry Deadline Withdrawal Deadline. 30 th – 31 st August 2014 26 th August 2014 28 th August 2014 .

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IC/BC/Passport No DOB

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  1. MSN Perak “Merdeka” Junior Tennis Championships 2014 Entry Form ENTRY INFORMATION Tournament Title MSN PERAK MERDEKA CLOSED JUNIOR TENNIS CHAMPIONSHIPS 2014 Tournament Dates Entry Deadline Withdrawal Deadline 30th – 31st August 2014 26th August 2014 28th August 2014 Email Address sahi3003@yahoo.com BOYS LTAMRanking (if any) FULL NAME (as per Mykad/BC/Passport) IC/BC/Passport No DOB GIRLS LTAMRanking (if any) FULL NAME (as per Mykad/BC/Passport) IC/BC/Passport No DOB ADDRESS/CONTACT NUMBER Address Phone No. In Case of Emergency Contact relationship Home : Mobile : Contact Person : Phone No : ENTRY FEE RM40 By Cash Bank in to Maybank account 1080 1184 5233 - Mr Leong CheeWai (Coach Jeff) (Please submit bank-in slip) Entry Fee Mode of Payment SIGNATURE OF PARENT/GUARDIAN (Please read and sign the attached Consent Form) Signature Name Entry Fee Signature Date

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