PERSATUAN EKONOMI MALAYSIA
(Malaysian Economic Association)
Attach
Passportsize Photo
(optional)
Membership Application Form
Name: (Tan Sri/Puan Sri/Dato’/Datin/Dr./Mr./Mrs./Ms.) .....………………………………….......
…………………………………………………………………………………………….………...
Date of Birth: ……………………………………. I/C No: ...…………………………………….
Academic/Professional Qualifications: …..………………………………………………………...
Organisation/Address: …….………….………………………………………………………….…
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Designation: ……………………………………………………………………………………….
Tel (O): …………………………Fax (O): ………………………. E-mail (O): ………………….
Home Address: …………………………………………………………………………………….
………………………………………………………………………………………………………
Tel: …………………………….. Fax: …………………………... E-mail: ……………………...
Mailing Address: …………………………………………………………………………………..
………………………………………………………………………………………………………
Tel: ……………………………..
Fax: ……………………………
E-mail: ……………...
Type of Membership
(
(
[
[
]
]
)
)
Life
Corporate
RM500
RM3,000 every 5 years
New Membership
Renewal of Membership
For Office Use Only
Membership ID No.:__________
Please send completed form together with your subscription and passport-size photograph to:
The Secretariat
Persatuan Ekonomi Malaysia
C/O New Block, Faculty of Economics and Administration
University of Malaya, 50603 Kuala Lumpur
Tel: 603-79560075/79673647, Fax: 603-79563139
E-mail: mgt@pem.org.my, Website: http://www.pem.org.my
All cheques should be crossed and made in favour of PERSATUAN EKONOMI MALAYSIA
Our CIMB account no : 80-0127927-9 (please email/fax payment slip for confirmation)
Signature: ………………………….
Date Joined: …………………..…