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Membership Application Form
Referrer Name
:
Personal Information
Salutation
*
SalutationTun
Tan Sri
Dato Sri
Datuk Sri
Dato
Datuk
Mr/Mrs
Others
Name In Full
*
NRIC / Passport No.
*
Gender
*
Male
Female
Marital Status
*
Single
Married
Divorce
Widow
Mobile No.
*
Email
*
Nationality
*
Cambodia
Hong Kong
Malaysia
Thailand
Residence Address
*
Mailing address
*
State
*
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Pulau Pinang
Perak
Perlis
Selangor
Terengganu
Sabah
Sarawak
Wilayah Persekutuan Kuala Lumpur
Wilayah Persekutuan Labuan
Wilayah Persekutuan Putrajaya
Company Title
Nature Of Business
*
Type Of Business
*
Sole Proprietorship
Partnership
Limited Liability Partnership (LLP)
Private Limited Company (Sdn Bhd)
Public Limited Company (Berhad)
Company Position
*
Product & Services
*
Company Name
*
Company Registration Number
*
Company official website
*
Membership Fees
Registration Fees
Life Time Member Fees
TotalFees
Declarations
Please understand and agree with the declarations
I confirm that all the above is true and I here by agree to adhere to the rules & regulations of the association.
I declare that I am not a bankrupt and I have never jailed for more than one year by any Malaysia court and never been fined for more than RM2,000.00 .
I fully understand that the Board of Committee reserves all right to terminate and/or reject my application at any time for misconduct and/or failure to compily with the rules and regulations set out thereaf.
Declaration4
Payment Supported:
Chinese Name
*
Date Of Birth
*
Home Tel No
*
Mobile Number
*
Fax No
URL
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Contact Information
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