Membership Application Form

The items marked in red are mandatory

Company name:
Company address:
Postal code:
City:
State:
Telephone:
Fax:
E-mail:
Website:
 
Principal representative
Salutation:
Surname:
First name:
Telephone direct line:
Designation:
Nationality:
Personal E-mail
 
Representative 2
Salutation:
Surname:
First name:
Telephone direct line:
Designation:
Nationality:
Personal E-mail
 
Representative 3
Salutation:
Surname:
First name:
Telephone direct line:
Designation:
Nationality:
Personal E-mail
 
Representative 4
Salutation:
Surname:
First name:
Telephone direct line:
Designation:
Nationality:
Personal E-mail
 
Date of incorporation in Malaysia:
Locally incorporated:Sdn Bhd
Berhad
Rep. Office
Locally incorporated (other)
Staff in Malaysia:
Paid up capital (million ringgit)
Business Sector (option 1)
Business Sector (option 2)
Business Sector (option 3)
Business Sector (other)
 
Sub comittee:
Business activity:
Membership type: