Bukit Larut Member Register

Please be informed that information provided below will be used as Identity Verification for transaction performed at this portal and events organized by Bukit Larut.
In the event of any dicrepancy with the information provided, Bukit Larut reserved the rights to void the transaction made or event participated.

First Name:

Last Name:

IC / Passport:

Email Address:

Password:

Confirm Password:

Phone:

Address 1:

Address 2:

Post Code:

City:

State:

Emergency Contact Person

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