Registration Form for WEBINAR: DARKNESS IN MY EYES
Assalamualaikum and Hello everyone !

We from the registration committee would like to welcome you by participating in our webinar. We would also like to ask you to register by filling in the relevant information.

Webinar details as below:

Title        : “ Darkness in My Eyes” – End The Stigma!
Date        :17th JULY, 2021 (SATURDAY)
Time       : 10.30am – 12.30pm
Platform : Zoom

Contact us:
Nadirah - 019 601 5552
Name (Nick name) *
Gender *
Nationality *
E-mail *
Contact Number (Optional)
What is your concern about your mental health? (Optional)
Why are you interested in knowing about mental health? (Optional)
If you are passionate about mental health issues, would you like to becoming one of our sponsors for webinar? *
If YES, please share your contact number.
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