Full Name (as per NRIC/Passport)

First Name Last Name

Preferred Name

MyKad/Passport No.

Gender

Male Female

Citizenship

Organization

Designation

Mailing Address:

Street Address

Street Address Line 2

City State

Postal Code Country

Telephone Number (Office):

Area Code Phone Number

Telephone Number (Home):

Area Code Phone Number

Telephone Number (Mobile):

Area Code Phone Number

E-mail (personal)

Facebook Link

Academic Qualification(s)

Professional Qualification(s)

Coach Learning From:

CCA Other

Please attach coach certificate

Membership Type

(1) Ordinary - 2-year membership at RM300 (If joining in 2nd half of the year = RM225) (2) Ordinary - 4-year membership at RM500 (If joining in 2nd half of the year = RM437.5) (3) Life - One-off payment of RM2,000 (4) Associate - RM100 for 1 year subscription (no subsidy for coaching camp, non renewable) (5) Corporate - RM1,200 for 1 year subscription for up to 12 persons (6) Global Member - One-off payment of RM300 (applicable only to those who residing outside Malaysia)

1. I hereby apply to be a member of the Malaysian Associataion of Certified Coaches (MACC).

2. I declare that all information given is true and correct.

3. I agree to abide by the Constitution and By-Laws as well as the Code of Ethics of the Association.

4. I also agree to pay the annual Subscription Fees which will be non-refundable in the event I decide to discontinue my membership with the Association

I have read, understood, and accepted the membership declaration.

Signature of Applicant

Clear

Date

Once you submit your application, we will contact you shortly to complete your membership application.

Thank you!

MALAYSIAN ASSOCIATION OF CERTIFIED COACHES

Declaration