Individual Registration Form

MEMBERSHIP APPLICATION FORM

I wish to apply for membership of the IKHTISAS KELAUTAN MALAYSIA (Association of Malaysia’s Maritime Professionals). Personal details are as follows:

INDIVIDUAL MEMBERSHIP

INDIVIDUAL REGISTRATION FORM

If you are human, leave this field blank.

Personal Details

Full Name *

Citizenship *

Date of Birth *

Passport Number *

NRIC No. *

Job Position

Home Address *

City *

Postcode *

Province/State *

Country *

Telephone No.

Handphone No. *

Fax No.

Personal Email Address *

Employer Details

Name of Employer

Address of Employer

City

Postcode

State

Country

Professional & Academic Qualifications

Professional Qualification *

Academic Qualification *

File Upload *

Drop a file here or click to upload Choose File

Maximum upload size: 2.1MB

(Kindly enclose photocopies of Professional (CoC or CoP)) and Academic Qualifications (Certificate, Diploma or degree), you can upload multiple files here. Only these types of upload files: jpg, jpeg, png, pdf, doc, docx

Agreement

Note: Successful applicants will be notified on procedure of banking in the RM50.00 Entrance Fee and appropriate Membership Fee once approved.

Click on "Submit" button to send this form. By clicking the submit button you are agree that 'All details given are correct and up to date' and 'Agreed to be contacted by IKMAL for announcements and other related matters'.

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