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MNS Hornbill Conservation Volunteer Programme 2010JKR 641, Jalan Kelantan, Bukit Persekutuan, 50480 Kuala Lumpur

Tel : 03-2287 9422 Fax : 03-2287 8773 E-mail : community@mns.org.my

Attn: Ms. Jessie Ong

YES, I would like to enroll in your MNS Hornbill Conservation Volunteer Programme.

APPLICANTS INFORMATIONName: Dr / Mr / Mrs / Ms* :

I.C. / Passport No:

Nationality:

Postal Address:

Telephone: Fax: H/P:

E-mail:

Trip date: T-shirt size* : S / M / L / XL / XXL

Rates: 4D 3N package:

[ ] RM230, MNS member (Membership no: _____________________)

[ ] RM300, Malaysian resident (non-MNS member)

[ ] USD150, International participant

[ ] RM170, Student

5D 4N package:

[ ] RM280, MNS member (Membership no: _____________________)

[ ] RM350, Malaysian resident (non-MNS member)

[ ] USD180, International participant[ ] RM220, Student

PAYMENT INFORMATIONI enclose RM/USD*________ (Cash / Chq / Bank Draft / MO / PO* no: _________________)

ORDebit my VISA / MASTERCARD* no: ________-________-________-_________

Name on card: ___________________________________________________

Amount: RM__________ Expiry Date (mm-yy): ______________

Signature: ________________________ Date (dd-mm-yy): _________________

ORBank-in to : Maybank 012 138 304 679 / HSBC 305 194 920 108 *Bank-in Date (dd-mm-yy): _________________

Note: Kindly send us the bank-in slip by e-mail or fax to 03-2287 8773.

* Please circle the appropriate. For Office Use Receipt no.:

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IMPORTANT1. Confirmation and full payment must be made two (2) weeks upon submission of form to MNS.2. Paid booking is confirmed booking.Note: All proceeds will be channeled into the MNS Hornbill Conservation Project.

Agreement1. I hereby agree to fully indemnify and absolve the organizers of the MNS Hornbill Conservation

Volunteer Programme and MNS, their employees and/or agent from any claim and/or liability

that may arise out of any damages, injury, death or loss of property howsoever arising from my

participation in the Hornbill Conservation Volunteer Programme.

2. I subscribe to the guidelines mentioned below:Dos and Dontsi. Volunteers are advised against swimming in the lake for the own safety. Please ensure a

guide is present if volunteers insist on swimming.

ii. No jungle trekking unaccompanied by a guide is permitted.iii. No collection of plants, seeds, insects and animals are permitted.iv. Please ensure you use a cap and have sun block at all times for protection.v. Alcohol and non-halal food are not allowed at the field accommodations.vi. No photography allowed during the Plain-pouched Hornbill counts, as we need the

volunteers full concentration on the counts.

vii. No loud music and campfires allowed. This is a village area and we must respect thecommunity that lives there.

viii.Please feel free to contribute photographs of the survey to MNS and our magazine,Malaysian Naturalist and upcoming website: www.hornbills.org

Do you have special dietary requirements? If yes, please state

In case of emergency, please provide 2 possible contacts for MNS to get in touch:

Name Home Tel / Mobile Number

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_____________________Signature

Date: