Permohonan Pendaftaran Ahli Baru Pertubuhan

Permohonan Keahlian

Sila isi semua ruang kosong.
Pendaftaran*
Nama*

First NameLast Name
No. K/P*
Alamat Rumah

Street Address

Street Address Line 2

CityState

Zip Code
Displin*
Jawatan
Gred
Alamat Pejabat

Street Address

Street Address Line 2

CityState

Zip Code
E-mel Rasmi*
E-mel Peribadi*
example@example.com
No. Tel. Pejabat

Area CodePhone Number
No. Tel. Bimbit*

Area CodePhone Number
Jenis Keahlian*
Yuran:

Pendaftaran: RM 30.00 (Sekali bayaran sahaja)

Ahli Seumur Hidup: RM 100.00 (Sekali bayaran sahaja)

Ahli Biasa: RM 30.00 (Diperbahrui setiap tahun)

Maklumat Bank

Nama Bank: MAYBANK

Nama Akaun: PERTUBUHAN PROFESIONAL JKR MALAYSIA

No. Akaun: 5643 4260 2041
Bukti Bayaran*

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