Name (Required)

Email Address (Required)

Gender (Required)

Date of Birth 出生日期 (Required)

Mobile number 电话号码 (Required)

Preferred Language 首选语言 (Required)

Marital Status 结婚与否 (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)

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)