YAYASAN KEBAJIKAN HAIWAN KEBANGSAAN MALAYSIA

MALAYSIAN NATIONAL ANIMAL WELFARE FOUNDATION (MNAWF)

No. 8, Jalan Tun Razak, 50400 Kuala Lumpur Tel: 03-40435113/40432420 Fax: 03-40413660
E-mail: secretary@mnawf.org.my www.mnawf.org.my

OBEDIENCE & AGILITY TRAINING COURSE APPLICATION FORM

(MEMBERSHIP APPLICATION FORM)
APPLICANT’S DETAILS
1. Name Title: Mr Ms Dato Datin Others

2. Date of Birth ( DD MM YYYY) 3. NRIC (Malaysians) Non-Citizens 4. Gender

Nationality: Male
Passport No.: Female
5. Mailing Address

Postcode City

6. Profession: Government University Private Sector Retired

7. Contact Number Mobile: Office: Home:
8. Email:
9. Festival Celebrated
Hari Raya Christmas Chinese New Year Wesak Deepavali Others

I’m interested to participate in the following MNAWF program:

Fund Raising Social Responsibility Animal Assisted Activities Animal Welfare Education

Are you a pet owner: Yes If yes, please (✓ ) Dog Cat Rabbit Reptile Bird Others
No

COURSES OFFERED CANINE’S DETAILS

Please Please Breed :
Course Member * Non-Member
Tick Tick
Puppy RM150 RM250 Name :
Basic RM150 RM250 Microchip :
Number
Pre-Novice RM150 RM250 Date whelped : Age:
Novice RM180 RM280
Gender : Male Female
Intermediate RM200 RM300
Open RM250 RM350 Spayed/Neutered : Yes No
Agility RM50 RM150 * Please attach a copy of the pedigree certificate.
* All donations will be channeled to the Foundation.
Membership Number( Compulsory):
* Includes RM 100 Membership fee MNAWF T-shirt size: M L XL

Date: Signature of Applicant:

Subscription Fee I enclose

Ordinary Member RM100 Membership Fee : Money Order/Cheque No:
*Donation : Cash for the amount of RM:
TOTAL : Direct Bank in : A/C No.514329415995 (Maybank)
* Tax Deductable Account Name : Yayasan Kebajikan Haiwan
Kebangsaan Malaysia
(Please fax the receipt for confirmation)

For MNAWF use only

Date application received : Amount paid :
Application approved by : Receipt no. :
Course approved for : Date issued :
Date approved :

Please return completed form to the Honorary Secretary

SURVEY

1. What is your purpose of attending this program?

Socialise pet Meet other pet owners Learn how to communicate with my dog
More obedient pet First time pet owner Other

2. Is your pet vaccinated? If yes, when?

Yes,
No

3. Prior to this, have you undergone any other dog training program? If yes, where?

Yes,
No

4. How many years have you owned dogs? years months

5. Currently, how many dogs do you own?

Name: Breed: Age:
Name: Breed: Age:
Name: Breed: Age:
Name: Breed: Age:
Name: Breed: Age:
6. Does your dog have any medical problems?

Yes, please specify

No

7. Is your dog safe with people and other dogs?

Yes No

8. What do you intend to achieve after 10 weeks of training?

DECLARATION

I agree and understand that this Application is subject to the absolute approval of the Malaysian National Animal Welfare
Foundation (MNAWF). On being accepted to participate in the Obedience & Agility Training Course, I agree to abide by all the Rules
and Regulations of the MNAWF and in particular to the rules governing Obedience & Agility Training. I also agree to indemnify and
save harmless the MNAWF and all its personnel involved in the Obedience & Agility Classes from any and all claims that may arise
from any incident during my participation in the training. MNAWF and its personnel will not be held responsible for any injuries or
mishap sustained by the trainees or their dogs during the Obedience & Agility Training or Competition.

I also agree that MNAWF have the right to exclude me from the course if I do not comply to the rules and regulations without
having to reimburse me for the fees paid.

I hereby confirm that I have read and understand all of the above.

Date :

Name :

Signature :

B. PROPOSED BY (Ordinary Member) FOR COMMITTEE USE ONLY

Name:
Membership No:
Membership No: Signature of Hon. Secretary

Name:
Signature: Date of Approval (DD MM YYYY)

Please ensure the Application Form is fully completed.