Name (Required)

Email Address (Required)

Gender (Required)

Date of Birth 出生日期 (Required)

Mobile number 电话号码 (Required)

Which part of Penang are you from ? 您来自槟城的哪一部分？ (Eg : Bayan Lepas, Ayer Itam, Bukit Mertajam etc..) (Required)

Marital Status 结婚与否 (Required)

I would like to be contacted to be placed in a LifeGroup. 我愿意被联系，以便被安排到生命小组。 (Required)