*Each form is for only one person. Spouse to use seperate form.

Name:_____________________________________________________

Sex: Male / Female	  Marital Status: Single / Married

Spouce Name (if attending):_______________________________

Mailing Address

Street add1:___________________________________________

Street add2:___________________________________________

City/Town :___________________________________________

State           :___________________________________________

Postcode:______________

Telephone (O):____________ Fax       :____________

	    (H):____________ Mobile:_____________

Email (if applicable):

__________________________________
Church / Organization:

__________________________________

Registration Fee RM125 pax inclusive of Registration Kit,
Souvenir Program, T-shirt, Name Tag.
Registration fee will be RM140 for enrolment after
January 1, 1999
Please tick -- Optional Transport Charges RM25
for trip from Ipoh to Cameron Highlands only

http://members.tripod.com/~StPetersIpoh/YoungAdultsCon/main.html
email: thesowers@hotmail.com

		Contacts: 
WON PUEI KUEN: 05-547 0394(O)  05-546 5034(H)
   St Peter's Church Ipoh     Tel/Fax: 05-546 0444
                Tel: 05-547 9576

I enclose RM_________(Bank Draft / MO / PO no:_____________________) 
as registration fee (please include RM0.50 for a charge of bank commission on 
outstation cheques). Please make cheque payable to "St. Peter's Church, Ipoh" 
and send it together with the completed form to:
	             The Sowers
	St. Peter's Church Ipoh, 
	            1-A, Fair Park,
	        31400 Ipoh, Perak.