PCM_headerlogo.jpg (23496 bytes)    Member List

MEMBERSHIP ON-LINE APPLICATION FORM
All the information below are required, incomplete registration will not be processed.

Full Name      
Nickname                        NRIC No  
(Nama panggilan - Max. 10 characters)                                          (No Kad Pengenalan)             
Date of Birth
Celebrate:   H.Raya   Chinese NY   Deepavali    X' Mas     Others

E-mail            H/phone No 
Occupation (Pekerjaan)
 Employer    (Majikan)

                                              Eg. No 123, Jalan Persiaran Kenanga Kiri, Condo Chenderawasih,
 Home Address         
                                   Taman Setiawangsa,                                  
Location/Taman      
                                   47100 Ampang,
Post Code & Town   
                                   Selangor.
State                        

Car Plat No   Model Eg: 405SRi      Auto   Manual   
Year                     Colour   Car Insured with

Select the activities that you like to participate:  
TT Session  DIY Session  Workshop/Supplier Visit  Sunday Drives  Getaway Convoy
Track Day  Charity Event Others, please specify below:
Like to participate in organising the events?:  YES    NO

How do you know PCM:  Internet  Friends  Car Sticker  Club Activities  Media
Why you want to join this Club  

Membership fee: 
RM50.00 - (Annual fee only RM20.00 + One time registration fee of RM30.00).
 Will pay thru Maybank counter Club Acct: 5143 0132 0153.
 Will pay on-line thru Maybank2U: 1142 6301 3754 (Paramjit Singh acct - PCM Treasurer).
Will send cheque payable to "Peugeot Club Malaysia"
Club address: Lot 43492, Jalan Klinik, Bukit Naga, 40460 Shah Alam, Selangor DE.

 * VERY IMPORTANT!!! Please SMS "Date, Car No & RM paid" to 019 2257589 or Click here to post it into Club Forum

By submitting this MEMBERSHIP ON-LINE APPLICATION, I declare that all information provided are true and complete to the best of my knowledge and belief. Should I be accepted, I agree to abide by the rules and regulations of Peugeot Club Malaysia. 

 Should you failed to submit this on-line registration, please advise us at admin@peugeotclubmalaysia.com 

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