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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).

Application Form for Membership

Name :
IC No. :
Nationality :
Date Of Birth :
Age :
Gender : Female Male
Occupation :
Permanent Address :
Mailing Address :
Home No. :
Office No. :
Mobile No. :
Email Address :
     
Are You A : BREAST CANCER SURVIVOR
    FAMILY MEMBER
    INTERESTED INDIVIDUAL
     
Subscription : Registration Fee (RM10.00) + Associate member (RM20.00)
    Registration Fee (RM10.00) + Life Member (RM200.00)
     
  

 

Membership Form (PDF Format): Download