APPLICATION FORM TO JOIN THE REGIONAL NETWORK COMMITTEE
Personal Details
Name: (in full): _________________________________________________________
Please print in block letters
Date of Birth: _____/_____/ _______ CIMA Contact ID number:___________________
(optional)
DD
MM
YEAR
Designation: ___________________________________________________________
Company: ____________________________________________________________
Please (√) one region based on your residing state:
Central
Southern
Northern
East Malaysia
Kuala Lumpur, Selangor and Pahang
Johor, Melaka and Negeri Sembilan
Perlis, Perak, Pulau Pinang, Kedah, Kelantan and
Terengganu
Sabah and Sarawak
Application form, resume and e-photo
Please attach a copy of your resume which should be no longer than 200 words together
with the application form. Applicant also required to send an up-to-date e-photo (Jpeg or
Tif).
Declaration
I ______________________________________________, the undersigned being a
member of the Chartered Institute of Management Accountants hereby confirm the
foregoing particulars are correct and declare that I consent to be a committee member of
the regional network and that I undertake to promote the interests of the Institute to the best
of my ability.
Signature:____________________________ Date: __________________________
Note: Kindly take note that an election will be conducted electronically if we receive
applications that exceed the maximum number required. Elections for the posts of
Chairman, Deputy Chairman, Secretary and Treasurer of the regional network will
also be conducted electronically.