Address: P.O. Box 343, Kuala Belait KA 1190, Brunei Darussalam
Telephone: (673) 3375168
Fax: (673) 3222293
E-mail: bruneichessfederation@hotmail.com Website: www.bruneichess.org.bn

NEW MEMBER REGISTERATION FORM

Ref no :

Name :
D.O.B :                                               Age :   
Gender :  Male Female                                    I/C - Passport no :
Status :   
Address :
               :
Email Address :
Contact no : Office :
Home : Fax no :
Occupation :
Student - ( i.e School ) 

I hereby declare the above information is valid

.................................................          

(                                              )          

Date :

OFFICIAL USE

Member no : __________
Member Name

:  ____________________________________________
Address           :  ____________________________________________
Contact no.   :  ____________________________________________
Entry fee   : ( Paid / Unpaid )
 
( Approve / Disapprove )
Remark : ____________________________________________

______________________

Federation  Secretary General