Registration Form

Profile Member

Informasi

Perorangan (individual) | Iuran Awal (Initial Fee) Rp. 500,000,- | Iuran Anggota (Membership Fee) Rp. 900,000,- | Perwakilan (Representative): 1 orang (person)
Perusahaan (Corporate) | Iuran Awal (Initial Fee) Rp. 5000,000,- | Iuran Anggota (Membership Fee) Rp. 3,600,000,- | Perwakilan (Representative): 3 orang (person)
Organisasi Nirlaba (Non-Profit Organization) | Iuran Anggota (Membership Fee) Rp. 900,000,- | Perwakilan (Representative): 1 orang (person)
Asosiasi (Association) | Iuran Awal (Initial Fee) Rp. 1000,000,- | Iuran Anggota (Membership Fee) Rp. 1,800,000,- | Perwakilan (Representative): 5 orang (person)

*/Iuran anggota dibayarkan langsung untuk 1 (satu) tahun (12 bulan)
*/Membership fee are paid for 1 (one) year (12 months)

* Membership Type

* Full Name

* Nickname

* Gender
Male Female

* Place of Birth

* Date of Birth

Document

Doc Number

* Company Name

* Position

* PIC Billing Name

* PIC Billing Position

* PIC Billing Phone

* PIC Billing Email

* Email

Refferal Code

Description

Address

* Phone 1

Phone 2

* Mobile Number

Fax

* Province

* City

* District

* Village

Zipcode

* Address

COMPANY

* Category

* Industry

* Product Type

* Product Market

* Establish Year

* Staff Size