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Icc Morocco-Andalusia Application Form

This document appears to be a registration form for an 8-day, 7-night tour of Morocco and Andalucía, Spain visiting Islamic historical sites from June 12-20, 2010 costing $2,999 per person all-inclusive. It requests basic contact information as well as passport and medical details from participants. Accompanying family members can register using a separate form.

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Assyakirin Mosque
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172 views

Icc Morocco-Andalusia Application Form

This document appears to be a registration form for an 8-day, 7-night tour of Morocco and Andalucía, Spain visiting Islamic historical sites from June 12-20, 2010 costing $2,999 per person all-inclusive. It requests basic contact information as well as passport and medical details from participants. Accompanying family members can register using a separate form.

Uploaded by

Assyakirin Mosque
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ASSYAKIRIN MOSQUE MANAGEMENT BOARD

REGISTRATION FORM Please attach


recent
REVISIT ISLAMIC CIVILISATION TOUR
passport
8D/7N MOROCCO - ANDALUCIA (SPAIN) photo
S$2,999 (FULL BOARD)
12th - 20th June 2010
FOR OFFICIAL USE:
Registration No. PAID/ NOT PAID AMOUNT : $ _________________
*CASH/NETS/CHEQUE NUMBER: __________________
Date: RECEIPT NO:________________ DATE: ________________
NAME OF ISSUING OFFICER: ________________________

ACCOMPANYING FAMILY MEMBERS : FATHER/MOTHER/ HUSBAND/WIFE/


DAUGHTER/SON/BROTHER/SISTER
Total No:
* please fill up a separate form for each participant
REQUIRED COPIES OF THE FOLLOWING DOCUMENTS:
NRIC/BC & PASSPORT MEDICAL RECORDS/ PRESCRIPTIONS
PARENTAL/GUARDIAN LETTER OF CONSENT (FOR INDIVIDUALS BELOW 21)
DIETARY/ALLERY NOTIFICATIONS
VACCINATION: MENINGITIS / INFLUENZA

NAME (AS PRINTED IN PASSPORT):

ADDRESS: APT BLK __________________________________ UNIT # _________________________

_______________________________________________________ SINGAPORE ____________________

OCCUPATION: ______________________________________ TEL: ( H ) ____________________

__________________________________________________ ( O ) ____________________

EMAIL: ________________________________________ H / P ____________________

DATE OF BIRTH: / / NRIC NO. S /

AGE: YEARS

PLACE OF BIRTH : NATIONALITY:

INTERNATIONAL PASSPORT NO:


DATE & PLACE OF ISSUE
PASSPORT EXPIRY DATE
* IN CASE OF EMERGENCY, PLEASE CONTACT
NAME OF NEXT OF KIN RELATIONSHIP CONTACT NUMBER
1)
2)

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