IPRM Membership Registration Form

The Institute of Public Relations Malaysia (IPRM)

10th Floor, Ministry of Communications, No. 4G9, Persiaran Perdana, Precinct 4, 62100, Putrajaya.

03-8911 7406

iprm.org.my@gmail.com

https://iprm.org.my

Personal Information

Name:

Gender: Male Female

Date of Birth:

Nationality:

NRIC No.:

Full Address:

City/Country:

Postcode:

Contact No.1:

Contact No.2:

E-Mail:

Designation:

Organization:

Address & Contact Details:

Summary of Job Descriptions:

Educational Background

Commence Date:

Employment Type:

Other Employment Type (if applicable):

Highest Level of Education:

Other Education (if applicable):

Institution Name:

Graduation Date:

Professional Background

Organization:

Designation:

Start Date:

End Date:

Certification

I am pleased to submit my application for admission to the Institute of Public Relations Malaysia.

Enclosed are the non-refundable entrance fee of RM100, a subscription fee of RM200, two passport-sized photographs, a copy of my identification card and copies of all my academic and professional qualifications.

I confirm that the information provided in this application is accurate and I agree to furnish any additional documentation that may be requested to support my application. If necessary, I will attend the interview arranged by the Membership Committee. I also agree to adhere to the decisions made by the Council.

Signature Of Applicant:

Date:

Reference

Reference 1

Name:

Designation:

Relationship:

Contact Number:

Email Address:

Date:

Reference 2