Name:
IC Number
Email Address:
Current Address
Contact Number
Are you Attending Xmybase Reunion?	YES NO
Who would you bring? please stated their name and age.

Put a website form like this on your site.


Xmybase Reunion

Tarikh dicadangkan: 24 Julai 2010
Masa: 9.00 pg - 2.30 ptg
Tempat: Sg Congkak Park n Resort, Hulu Langat, Selangor.
Tema: Black n Red
Bayaran: RM 42-45.00 (Dewasa), kanak2 bawah 12 thn PERCUMA.


KEHADIRAN MELALUI BORANG DI ATAS SEHINGGA 25.05.2010
Dewasa: 17 orang (termasuk ahli keluarga)
kanak-kanak= 9