Member Registration

Prudential ID

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Full Name

NRIC Number NRIC Number (eg: xxxxxx-xx-xxxx)

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Position QA - Quality Agent | QL - Quality Leader

Date Contracted as Agent

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Home Phone

Office Number

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School/Collage/University

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Highest Qualification

Shirt Size

Meal Option

Event Breakout Session Language

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I hereby acknowledge the following: I declare that the information given herein are correct to the best of my knowledge and belief.
I agree to be govern by the rules and regulations of PRULIA as they now exist as they may hereafter be altered.
I hereby authorize Prudential Assurance Malaysia Berhad to debit by commission account for the annual subscription
By ticking this confirmation box, I'm hereby agree to receive newsletters, notice of upcoming events and other news related to PRULIA via my registered Email