Registration – DianeSera.com

Name*

Full Name

IC Number*

Please enter your 12 digit NRIC number

Address*

Street Address City State Postcode

Email*

Phone Number*

Date of Birth*

Enter your date of birth

Height*

Enter your height in centimeters (cm)

Marital Status*

Single
Married
Divorced

Select your marital status

Children/Kids*

Enter the number of children/kids that you have

Religion*

Select your religion

Occupation*

Have you joined a program before?*

Yes
No

If you have previously signed up for a program select Yes. If you are a new/first-time participant select No

Select a program/package*

Select your desired program and package

Choose your payment amount*

Full Amount
50% Deposit

Choose whether to pay the full amount now or a 50% deposit.

Product Name

Price: RM 0.00

Product Name

Price: RM 0.00

Total

RM 0.00

Choose your payment method*

Online Payment (Card/Internet Banking)
Bank Transfer

Choose to pay via Online Banking (FPX) or Bank Transfer (IBG)

Please make payment to :

Account Number : 212121212
Account Name : STRENGTH SIFOO SDN BHD
Bank Name : MAYBANK

Once payment has been transferred, please upload the payment slip below.

Upload Payment Slip/Receipt*