Form Registrasi Anggota – English

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Complete Name: *

Place & Date Of Birth : *

Nationality : *

ID **/Passport *) : *

Last Education : *

Other Degree : *

Course/Certification :

Current Job :

Other Skills :

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*) you can checklist (V) more than one

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Mobile & Whatsapp : *

IG :

Email *

FB :

*) Mandatory For Distinguished Level

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1.

2.

3.

4.

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1) Copy of ID / Passport

2) Copy of Tax ID (IDN)

3) Copy of Certification (if any)

4) Name Card (for profesional)

5) Your Best Photo *)for the yearbook

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We hereby complete this form with accurate information for the purpose of applying for membership of Indonesia Technology Information & Communication Practitioners Association.

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I hereby consent to abide by the Articles of Association and Bylaws of Indonesia Technology Information & Communication. Practitioners Association and all regulations and provisions issued by Indonesia Technology Information & Communication Practitioners Association