Ricoi's Online Membership Form

 

YOUR PERSONAL PARTICULARS

 

Full Name:

 

Other Name(s) (if applicable):

 

I/C or Passport No:

 

Nationality:

 

Date of Birth:

 

Sex: Male Female

 

Place of Birth:

 

Marital Status:

 

If married, state name of Spouse:

 

Home Address:

 

Home Tel. No:

 

H/Phone No:

 

E-mail:

 

Fax No:

 

Name(s) of children (if any):

 

1.

 

2.

 

3.

 

4.

 

5.

 

6.

 

 

YOUR EMPLOYMENT PARTICULARS

 

Name of Company / Employer:

 

Office Address:

 

Job Title:

 

Office Tel. No:

 

E-mail:

 

Fax No:

 

PLEASE NOTE:

 

1. The entrance fee for ORDINARY and ASSOCIATE membership is RM 10.00

 

2. The annual membership fee for ORDINARY and ASSOCIATE member is RM50.00

 

3. For LIFE membership, a one-time fee of RM1,000.00 is payable without any further subscription

 

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