ࡱ> #` 6bbjbjmm .v` 2222222F###9x:F2,#&%%%%&($)?1A1A1A1A1A1A1$43h5\e1]2C*&&C*C*e122%%1,,,C*2%2%?1,C*?1,,22,%$; weBh#*.,.T102,5*5,,52G-C*C*,C*C*C*C*C*e1e1, C*C*C*2C*C*C*C*FFF  FFF FFF222222  HASH HOUSE PATRON APPLICATION Hash House Patrons become Life Members and names will be displayed on the wall of the Hash House when completed. Patron members are recognised at four levels relative to donation amount. To apply to become a Hash House Patron, complete this form and send it with full payment "Torch" Bennet Minimum US$ 2000  FORMCHECKBOX  "Horse" Thomson Minimum US$ 5,000  FORMCHECKBOX  Cecil Lee - Minimum US$ 10,000  FORMCHECKBOX  G Gispert Minimum US$ 20,000  FORMCHECKBOX  DONATION VALUE RINGITS FORMTEXT      orUS DOLLAR FORMTEXT       FAMILY NAME  FORMTEXT      OTHER NAMES FORMTEXT       DATE OF BIRTH FORMTEXT      PERSONAL DETAILS MAILING NAME FORMTEXT      ADDRESS FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      TELEPHONE FORMTEXT      MOBILE PHONE FORMTEXT      EMAIL FORMTEXT      HASHING DETAILS CURRENT HASH CHAPTER FORMTEXT      PREVIOUS HASH CHAPTER FORMTEXT      HASH NAME (if any) FORMTEXT      BRIEF HASHING HISTORY  FORMTEXT       Signature or mark  FORMCHECKBOX  Payment is being made by Bank Draft (enclosed)  FORMCHECKBOX  Payment has been Made by Bank Transfer (details enclosed)  FORMCHECKBOX  Payment is being made by Credit Card VISA  FORMCHECKBOX  MasterCard  FORMCHECKBOX  AMEX  FORMCHECKBOX  DONATION PAYMENT BY CREDIT CARD CREDIT CARD DETAILS CARD NUMBER FORMTEXT      EXPIRY DATE FORMTEXT      NAME ON CARD FORMTEXT      Card CVV/CSV FORMTEXT       DATE FORMTEXT       Signature or mark  FORMCHECKBOX  BANK TRANSFER Beneficiary's Bank Name: HSBC BANK MALAYSIA BERHAD, MALAY/;<  R S T U [ c d sesTFhB*OJQJ^Jph!h+h+B*OJQJ^Jphh+B*OJQJ^JphhEB*OJQJ^Jph h9L0J h0J ha:0J h+0J hRt0J#hRth5CJOJQJ^JaJh+5CJOJQJ^JaJhRt5CJOJQJ^JaJhhn0J5CJ$aJ$h+0J5CJ$aJ$hRt0J5CJ$aJ$hnjhRtU;<R S J L j z $Ifgd@$a$gdn [$\$gd+gd+ 7$[$\$gd+$a$gd9L gd+ gd+8&]gd+btd e m t u v w 㘱ĊĊĊw^wJ'h+h+5B*OJQJ\^Jph0j֓hh@B*OJQJU^Jph$jhB*OJQJU^JphhB*OJQJ^Jph0jbh-"}h-"}B*OJQJU^Jph$jh+B*OJQJU^Jph!h+h+B*OJQJ^Jphh|B*OJQJ^Jphh+B*OJQJ^JphhEB*OJQJ^Jph    $ & ( D ugYgugugFg$jh9LB*OJQJU^JphhEB*OJQJ^Jphh9LB*OJQJ^Jph!h+h+B*OJQJ^Jph6jJh9Lh@5B*OJQJU\^Jph!h9L5B*OJQJ\^Jph*jh9L5B*OJQJU\^Jph'h+h+5B*OJQJ\^Jph!hE5B*OJQJ\^Jph!h5B*OJQJ\^JphD F H J L h j z | û~hS~~=S*jha:h@5OJQJU^J)jha:5OJQJU^JmHnHu*j6ha:h@5OJQJU^Jha:5OJQJ^Jjha:5OJQJU^Jha:ha:5OJQJ^Jha:hn0J5ha:h9L0J5h+B* ph!h+h+B*OJQJ^Jph$jh9LB*OJQJU^Jph0jh9Lh@B*OJQJU^Jph ?7$a$gdnkd"$$IflrxlD%  8 t0644 layta: $Ifgd@      ( * D F Z \ ^ h j ˱ٙٙeٙWD$jhr#h95OJQJU^Jhr#hn5OJQJ^J3jBhr#h15B*OJQJU^Jph"3j=hr#h15B*OJQJU^Jph"/jhr#h90J5CJUaJmHnHu3jɖhr#h15B*OJQJU^Jph"hr#h90J5CJaJ$jhr#h90J5CJUaJhr#hn0J5CJaJ hn0J  , D l n p OG$a$gdnkd$$Ifl\'%k & t0644 laytn $$Ifa$gdnp  ld[[ $Ifgdn$a$gdn}kd$$Ifl0+ t0644 laytn $$Ifa$gdn $Ifgdn    . 0 D F H R T Z \ p r t ~ ȰȢȰȢvȰȢ`ȰȢ*jhr#h15OJQJU^J*j՚hr#h15OJQJU^J*jhr#h15OJQJU^Jhr#hn5OJQJ^J/jhr#h95OJQJU^JmHnHu$jhr#h95OJQJU^J*jhr#h15OJQJU^Jhr#h95OJQJ^J  . 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Open HHPATRONAPP and complete form by entering appropriate information and tabbing between fields. When complete "Save as" familynameHHPATRONAPP. Eg smithHHPATRONAPP Despatch of Applications The saved form "familynameHHPATRONAPP can simply be emailed as an attachment with the email message containing date bank tranfer was made. Alternatively the saved form "familynameHHPATRONAPP" could be printed, signed and airmailed along with a copy of the Bank Transfer Details. 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