Membership Registration Form

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• Personal Details
• Family Details
• Contact Details
• Medical Questionnaire
• Declaration

Personal Details

Given Name*

Family Name*

Race*

Date of Birth*

×

Marital Status*

-- Select --SingleMarriedWidowedDivorced

Nationality*

Place of Birth (City)*

Gender*

-- Select --MaleFemale

Preferred Language*

-- Select --MalayEnglishOthers

Place of Birth (Country)*

-- Select --BruneiMalaysiaOthers

Current Address*

Postcode*

Current Country*

-- Select --Brunei DarussalamOther (Specify)

Write here

Current District*

-- Select --Brunei-MuaraTutongBelaitTemburong

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Supporting Details

Supporting Documents*

Please pick one supporting document

-- Select --Identification CardPassportBirth Certificate

Identification Card No.*

Passport no.*

Birth Certificate no.*

Identification Card Colour*

-- Select --YellowRedGreenOthers

Upload Passport

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Upload Birth Certificate

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Upload Identification Card (Front)

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Upload Identification Card (Back)

Max file size: 976.56 KB. | Allowed file types: gif,jpeg,png,jpg | Min number of file: 1

Select Files

Family Details

Guardian 1

Full Name*

Relationship with applicant*

Phone Number*

Occupation*

Email*

Guardian 2

Full Name*

Relationship with applicant*

Phone Number*

Occupation*

Email*

Contact Details

Phone Number*

Additional Phone Number

Email Address*

Additional Information

Height (cm)*

Club Name (If any)

Weight (kg)*

Preferred foot*

-- Select --LeftRight

Medical Questionnaire

Are there any medical conditions of which the association should be aware of?*

Yes

No

Please State*

Are you currently taking any medication of which the association should be aware of?*

Yes

No

Please State*

Emergency Contact Information

Name of Emergency Contact*

Phone*

Phone

Relationship with applicant*

Address*

Declaration

Please tick the relevant circle*

I hereby that I comply with FITEQ's integrity policies, anti-doping regulations and other relevant FITEQ by laws.

I hereby agree to the terms and conditions.

I hereby declare that all of the information provided is correct at the time of completion and I understand that if anything changes I must inform Brunei Teqball Association

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Registration Successful

Your application has been submitted
An email should be sent to your mail in upcoming regarding the status of your application!
Thank you!

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