Please fill in the following fields. Fields marked with an * are required.
请填写以下表格。（*）代表必须填写的部分
Gender 性别:
 男 Male   女 Female 
*English Name姓名（英）:
  
Chinese Name姓名（中）:
  
* NRIC/PASSPORT NO.
登记/护照号码:
  
Date of Birth 出生日期:
 (eg. 24/06/1972)
Street Address 1 :
地址 1  
 eg. Blk 2 Ang Mo Kio Ave 2
Street Address 2:
地址 2 
 eg. #06-15   Ocean Court
State 省 :
 
City 市 :
 
Country 国家 :
 
Postal Code 邮区
  
*Email 电子信箱 :
* Tel.联络号码 :
(Home 住宅) (Mobile 手机)
(公司 Office) (传真 Fax)
Please tick the button of the amount you wish to contribute.
For other amount, please tick the "Other amount" button and enter the amount in the box.
SGD $10
Enets Internet Banking
(Please have a valid Internet Banking account with Citibank, DBS/POSB or UOB)
Credit Card
 
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