Formulir Pendaftaran Anggota MASTEL
Bersama ini kami menyatakan berminat untuk bergabung sebagai anggota MASTEL
We are interested to join as a MASTEL member
Kategori Keanggotaan (Membership Category)
Perorangan (individual) | Iuran Awal (Initial Fee) Rp. 500,000,- | Iuran Anggota (Membership Fee) Rp. 75,000,- | Perwakilan (Representative): 1 orang (person)

Perusahaan (Corporate) | Iuran Awal (Initial Fee) Rp. 5000,000,- | Iuran Anggota (Membership Fee) Rp. 300,000,- | Perwakilan (Representative): 3 orang (person)

Organisasi Nirlaba (Non-Profit Organization) | Iuran Anggota (Membership Fee) Rp. 75,000,- | Perwakilan (Representative): 1 orang (person)

Asosiasi (Association) | Iuran Awal (Initial Fee) Rp. 1000,000,- | Iuran Anggota (Membership Fee) Rp. 150,000,- | 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)

Kategori / Category *
Data Pribadi (Personal Data)
Nama Lengkap (Full Name) *
Your answer
Nama Panggilan (Nick Name) *
Your answer
Tempat Lahir (Birth Place) *
Your answer
Tanggal Lahir (Date of Birth) *
MM
/
DD
/
YYYY
Alamat (Home Address)
Your answer
Telepon Seluler (Mobile Phone) *
Your answer
Telepon Kantor/Rumah (Fixed Phone) *
Your answer
Nomor Fax (Facsimile)
Your answer
Email *
Your answer
Data Perusahaan (Corporate Data)
Nama Perusahaan (Corporate Name) *
Your answer
Jabatan (Position) *
Your answer
Alamat Perusahaan (Company Address) *
Your answer
Bidang Usaha (Line of Business)
Your answer
Jenis Produk (Kind of Products) *
Your answer
Pemasaran Produk (Distribution of Products) *
Required
Beroperasi Sejak (In Operation Since) *
MM
/
DD
/
YYYY
Jumlah Karyawan (Number of Employees) *
Your answer
Telepon (Phone) *
Your answer
Nomor Fax (Facsimile)
Your answer
Contact Person
Nama *
Your answer
Telepon Selular (Mobile Phone) *
Your answer
Email *
Your answer
Masyarakat Telematika Indonesia
Jl. Tambak Raya No. 61, Pegangsaan Jakarta 10320
Telepon: (62 - 21) 3190 8806, 3190 8812 | Fax: (62 - 21) 3190 8812
Email: info@mastel.id | Website: http://www.mastel.id
Pembayaran (Payment)
Pembayaran harap ditransfer ke rekening (please transfer the payment to):

Rekening Bank Mandiri (Account Number): 126.0001065688 a/n MASTEL
Jakarta Melawai, Jl. Melawai Raya 12 - 14,
Kebayoran Baru - Jakarta Selatan

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