wREGA_Membership Application
Section 1
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Email *
*
Professional
Associate
Student
Industrial Partner
Type of Membership
Title
NRIC Name *
NRIC Number *
Gender *
Required
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
Address (home)
Organisation / Institution Name *
Address (work/study) *
Telephone (work/study) *
Mobile (personal) *
Email (work/study) *
Email (personal) *
Academic Qualification(s) *
Professional Experience(s) *
Areas of Specialty / Expertise *
Areas of Interest / Volunteerism
Committee Leader
Committee Member
Membership & Recruitment Committee
Comm. PR & Events Committee
Ethics & Disciplinary Committee
Education & Research Committee
Publication & Content Committee
Awards & Sponsorship Committee
Clear selection
Declaration
I hereby have read, understand, and agree to the terms & conditions of my membership application to the best of my knowledge, thus abiding the rules, regulations, and by-laws stated in the Constitution of Pertubuhan Wakaf Reka Grafik Malaysia (wREGA). I clarify that information provided on this application form is to the best of my knowledge correct.
Name as Signature *
Date *
MM
/
DD
/
YYYY
Submit
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