Breast Cancer Welfare Association
 
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Be a Member

Although the majority of our members are breast cancer survivors, we do welcome interested individual as well. In fact, a small number of our members are made up of family members of survivors and interested individuals. By joining us, you can receive our quarterly newsletter "Chatline", participate in our social activities such as make-overs (for survivors only), visit interesting places or even join our dragon boat team; the Pink Challengers whether as supporters or paddlers.

To sign up as a member, fill in the online form and mail it back to us together with your cheque of RM30.00. (One time registration fee: RM10.00 and Annual Fee: RM20.00).
Membership Form (PDF Format): Download

Application Form for Membership

Personal Info
Name :
Email Address :
Password :
     
IC No. :
Nationality :
Date Of Birth :
Age :
Gender : Female Male
Occupation :
Permanent Address :
Mailing Address :
Home Tel No. :
Office Tel No. :
Mobile No. :
     
Are You A : BREAST CANCER SURVIVOR
      Date of Diagnosis (dd/mm/yyyy)
    FAMILY MEMBER (State Relationship and name of survivior)       
    INTERESTED INDIVIDUAL
     
Hobbies/Activities of Interest :
     
Subscription : Entrance Fee: RM 10.00
    Annual Subscription Ordinary / Associate Member: RM 20.00
    Life Member: RM 200.00 (Entrance Fee Waived)
Payment by cash or cheque to "Breast Cancer Welfare Association" (Amount RM: )
 
I declare that I will abide by the rules of Association