IMM Printable Application Form

 

IMM REGISTRATION FORM
YOUR NAME			DATE
YOUR TITLE			OTHER AFFILIATIONS
NATURE OF BUSINESS			MAILING ADDRESS
BUSINESS ADDRESS			STATE
TOWN			HOME TELEPHONE
POSTAL CODE			HAND PHONE NO.
BUSINESS TELEPHONE			FAX NO.
POST BOX NO			E-MAIL ADDRESS
			I.C. No.
	TYPE OF MEMBERSHIP:	Check Box
	Honourary Fellow
	Fellow
	Ordinary Member
	Associate Member
Were you referred by one of our members? If so please give their name:
Please enclose check with application.

Join IMM today and see the value it brings to you and your organisation.

Please complete our printable form above or go to our online from (prior to sending payment).

info@imm.org.my