[TEST] Template Form Testing [!TEMPLATE] [PILLAR] Al-Khaadem Program HiddenDate of Event Day Month Year Please be advised that this event will be conducted in English This event is for ONLY Ages to BILLING INFORMATIONFull Name* E-mail* Phone*Number of Participants*1234This event is fully booked. Donate to support our cause at bit.ly/infaq2021#1 PARTICIPANT DETAILSSame as in 'Billing Information' Participant #1 is the same as 'Billing Information' Full Name Same as in 'Billing Information' Phone Number Same as in 'Billing Information' E-mail Same as in 'Billing Information'Full Name* Phone Number*Please include the country code as well (e.g. +60123456789)E-mail*An info pack will be sent via email upon registration Enter Email Confirm Email Age*Gender* Male Female State*Wilayah Persekutuan Kuala LumpurSelangorJohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakTerengganuWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaInternational (Outside Malaysia)International* #2 PARTICIPANT DETAILSFull Name* Phone Number*Please include the country code as well (e.g. +60123456789)E-mail*An info pack will be sent via email upon registration Same as email(s) above Enter a different email Enter E-mail Address* Enter Email Confirm Email Age*Gender* Male Female State*Wilayah Persekutuan Kuala LumpurSelangorJohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakTerengganuWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaInternational (Outside Malaysia)International* #3 PARTICIPANT DETAILSFull Name* Phone Number*Please include the country code as well (e.g. +60123456789)E-mail*An info pack will be sent via email upon registration Same as email(s) above Enter a different email Enter E-mail Address* Enter Email Confirm Email Age*Gender* Male Female State*Wilayah Persekutuan Kuala LumpurSelangorJohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakTerengganuWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaInternational (Outside Malaysia)International* #4 PARTICIPANT DETAILSFull Name* Phone Number*Please include the country code as well (e.g. +60123456789)E-mail*An info pack will be sent via email upon registration Same as email(s) above Enter a different email Enter E-mail Address* Enter Email Confirm Email Age*Gender* Male Female State*Wilayah Persekutuan Kuala LumpurSelangorJohorKedahKelantanMelakaNegeri SembilanPahangPerakPerlisPulau PinangSabahSarawakTerengganuWilayah Persekutuan LabuanWilayah Persekutuan PutrajayaInternational (Outside Malaysia)International* PROGRAMME FEESYour placement is only confirmed when payment is fully paid Placement is by first-come first-served basis Any payment made will not be refunded Upon confirmed registration and payment, we will email you further details of the event For further clarification please contact us via WhatsApp: +60104551034 or email us at: events@alkhaadem.com Price Price: Total Fees RM 0.00 PAYMENT METHODChoose Payment Method*Online Transfer (FPX)Credit/Debit Card (Visa/Mastercard Only)ATM / Direct TransferPlease note that once payment has been completed via Credit/Debit Card, the page will return to the registration form and your registration is considered complete. For confirmation, please contact us at events@alkhaadem.com to confirm that your slot has been entered into the system. We apologise for any inconvenience. Please transfer the total amount to: 5623 5711 4347 FOQUS AKY SDN BHD (Maybank) Keep the payment slip and upload it below:Upload Proof of Payment*Max. file size: 1 GB.Where did you hear about this programme?* Al-Khaadem Facebook Al-Khaadem Instagram Al-Khaadem Whatsapp broadcast Al-Khaadem events/programmes Al-Khaadem Website Qalby App Recommendations from others Others Who?*(Family, friend, co-worker, etc.) Others*
