Home » Membership » Apply for Membership Apply for Membership Please complete the form below to submit your membership application. Alternatively, you may download, scan, and e - mail the completed form to *protected email*. MDBC-Membership-Form-2024.docx MDBC-Career Membership-Form-2024.docx Step 1 of 5 20% Company InformationCompany Name* Address* Address Line 1 Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Company phone numberCompany Email* Website Year of Incorporation Please fill in any / all that are applicableMalaysia Netherlands Global Locally Incorporated Sdn Bhd Berhad Representative Office Number of StaffMalaysiaNetherlandsGlobalBilling InformationMembership Fees are payable on an annual basis, valid from 1 January to 31 December; after 1 July the membership fee for new members is pro - rated at half the annual fee. Memberships are automatically renewed in January of each year, with invoices mailed out during the first half of that January.Person to Invoice* Email* Company Information ONLY fill in this section IF the information is different from what is provided above.Company Name ONLY if the company name is different from the one listed above.Address Address Line 1 Address Line 2 City State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ONLY if the billing address is different from the one listed above. Membership Type Please review our Membership Packages before selecting one below. I am registering as...* A business in Malaysia in the Klang Valley, Penang, or Johor A business in Malaysia (outside the above areas), ASEAN / APAC, or The Netherlands An individual Please note: If you are interested in the Career Membership, kindly go to the link at the top of the page, download the membership form, and e mail the completed form to *protected email*.Corporate Membership*For companies in Malaysia in the Klang Valley, Penang, or Johor. Gold (RM 5,800) Silver (RM 3,000) Orange (RM 1,800) Corporate Membership (Outstation)*For companies in Malaysia (outside of the Klang Valley, Penang, or Johor), ASEAN / APAC, or in The Netherlands. Outstation – Malaysia / ASEAN /APAC (RM 1,000) Outstation – Netherlands / EU (€ 250) Individual MembershipFor individuals without corporate representation. This is for Individual Membership ONLY. If you are interested in registering for the Career Membership, kindly click on the link at the top of the page to download the Career Membership Form. Price: Total RM 0.00 Total € 250.00 Company RepresentativesIn order to provide you with the membership services that the Malaysian Dutch Business Council (MDBC) has to offer, it is necessary for MDBC to process your personal data. You and applicable colleagues from your company will be included in the MDBC e mail database so that you will be able to receive our information and event announcements. By filling in this membership form, you are stating your agreement to allow MDBC to use and process your personal data and that of your applicable colleagues. You and your colleague(s) may opt out of certain communication options at any time but please note that it may affect MDBC's ability to delivery all of our products and services to you. Your personal data is important to us. MDBC is committed to ensuring that your personal data is used and protected in accordance to the applicable laws and in accordance to our Privacy Policy (which can be viewed at any time on the MDBC website: https://www.mdbc.com.my/information/privacy-policy/Representative 1 Principle RepresentativeName* Mr.Mrs.MissMs.Dr.Prof.DatukDatin Prefix First Last / Family name Designation / Job Title* Nationality* Phone*Direct line / Mobile numberWhatsapp Number Yes, please add this numberIf you would like this number to receive our WhatsApp Broadcast updates (for alert messages, confirmations, and general info: e.g. important info, event registration (confirmation and updates), etc.) then click yes. Email* Direct emailConsent*MDBC complies with both GDPR and PDPA. By clicking on "Yes, I agree", you explicitly allow the collection and processing of your personal data by MDBC (which may include the transfer of your personal data outside of Malaysia) in accordance with our Privacy Policy. Please note: If you do not agree to the collection and processing of your personal data, MDBC regrets that we will not be able to accept your membership application. Yes, I agree No, I do not Representative 2 For Corporate Memberships onlyName* Mr.Mrs.MissMs.Dr.Prof.DatukDatin Prefix First Last / Family name Designation / Job Title* Nationality* Phone*Direct line / Mobile numberWhatsapp Number Yes, please add this numberIf you would like this number to receive our WhatsApp Broadcast updates (for alert messages, confirmations, and general info: e.g. important info, event registration (confirmation and updates), etc.) then click yes. Email* Direct emailConsent*MDBC complies with both GDPR and PDPA. By clicking on "Yes, I agree", you explicitly allow the collection and processing of your personal data by MDBC (which may include the transfer of your personal data outside of Malaysia) in accordance with our Privacy Policy. Please note: If you do not agree to the collection and processing of your personal data, MDBC regrets that we will not be able to accept your membership application. Yes, I agree No, I do not Representative 3 For Gold & Silver Corporate Memberships onlyName* Mr.Mrs.MissMs.Dr.Prof.Datuk Prefix First Last / Family name Designation / Job Title* Nationality* Phone*Direct line / Mobile numberWhatsapp Number Yes, please add this numberIf you would like this number to receive our WhatsApp Broadcast updates (for alert messages, confirmations, and general info: e.g. important info, event registration (confirmation and updates), etc.) then click yes. Email* Direct emailConsent*MDBC complies with both GDPR and PDPA. By clicking on "Yes, I agree", you explicitly allow the collection and processing of your personal data by MDBC (which may include the transfer of your personal data outside of Malaysia) in accordance with our Privacy Policy. Please note: If you do not agree to the collection and processing of your personal data, MDBC regrets that we will not be able to accept your membership application. Yes, I agree No, I do not Representative 4 For Gold Corporate Memberships onlyName* Mr.Mrs.MissMs.Dr.Prof.Datuk Prefix First Last / Family name Designation / Job Title* Nationality* Phone*Direct line / Mobile numberWhatsapp Number Yes, please add this numberIf you would like this number to receive our WhatsApp Broadcast updates (for alert messages, confirmations, and general info: e.g. important info, event registration (confirmation and updates), etc.) then click yes. Email* Direct emailConsent*MDBC complies with both GDPR and PDPA. By clicking on "Yes, I agree", you explicitly allow the collection and processing of your personal data by MDBC (which may include the transfer of your personal data outside of Malaysia) in accordance with our Privacy Policy. Please note: If you do not agree to the collection and processing of your personal data, MDBC regrets that we will not be able to accept your membership application. Yes, I agree No, I do not Communication OptionsIn order for MDBC to provide you with the full extent of our products and services we would like to encourage you to sign up for the top option. Otherwise, please choose from at least one of the general / bulk e mail communication options below that. Please note this is separate from the direct e mails we will send you. You have control over the general communication options and you can change the e mails you receive from us by modifying your preferences at the bottom of any of our bulk e mails once you start receiving them. We would like to STRONGLY recommend that you opt into receiving our bulk e mails as it will help keep you updated on the latest events and news related to the (business) community.I want to receive... ALL electronic communications (all event invitations and reminders, monthly newsletter, and other general announcements) If you would like to receive ALL communication from us, please select this option. OTHERWISE, please select which option(s) you would prefer from the next segment.A la carte options: Select All ALL event invitations / reminders Weekly event invitations / reminders (summary) e - Update (electronic newsletter) MDBC General Announcements SIP Opportunities (Info on available Dutch interns) Career Opportunities (Available new talent for your organization) You may select multiple options from the above. Business ActivitiesPrimary Business Sector* Agriculture & Timber Automotive Chemicals, Cosmetics, Medical, Pharmaceuticals, Biotechnology Construction & Infrastructure Consultancy & Services Consumer Products & Appliances, Food & Beverages Corporate Services, Financial, Human Resources, Insurance, Legal Diversified Conglomerate Education Entertainment & Production Exhibitions, Hospitality & Tourism Government Statutory Body ICT Individual Members Logistics, Transportation, Distribution & Storage Manufacturing Oil, Gas & Power Trading Please select the sector that is most relevant. You can only select one Primary Sector.Secondary Sector Agriculture & Timber Automotive Chemicals, Cosmetics, Medical & Pharmaceuticals Construction & Infrastructure Consultancy & Services Consumer Products & Appliances, Food & Beverage Corporate Services, Financial, HR, Insurance, Legal Diversified Conglomerate Education Entertainment & Production Exhibitions, Hospitality & Tourism Government Statutory Body ICT Logistics, Transportation, Distribution & Storage Manufacturing Oil, Gas & Power Trading Please select any relevant sectorsBusiness Activities*Will be published in the MDBC magazineConfirmationMemberships are automatically renewed in January of each year, with invoices mailed out during the beginning of the new year. Should you wish to discontinue your membership for the following year, please notify us in writing before the end of December.Name* Designation* Consent*MDBC complies with both GDPR and PDPA. By clicking on "Yes, I agree", you explicitly allow the collection and processing of your personal data by MDBC (which may include the transfer of your personal data outside of Malaysia) in accordance with our Privacy Policy. Please note: If you do not agree to the collection and processing of your personal data, MDBC regrets that we will not be able to accept your membership application. Yes, I agree No, I do not CAPTCHANameThis field is for validation purposes and should be left unchanged.
