NEW MEMBERSHIP REGISTRATION
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Name :
Date of Birth :
No IC/Passport No :
Patron Categories :
ICT Administrator IIM
Super Administrator IIM
Institusi Korporat / Badan Organisasi / Organisasi Syarikat Swasta / NGO
Agensi - Agensi Kerajaan dan Badan Berkanun
Universiti Awam (IPTA) & Kolej (IPTS)
Individu
Ahli - Ahli PERPUN
Guest
Pengurusan Atasan
Ahli Lembaga Pengarah IIM
Staf IIM
Staf IIM Sementara (PSH)
Library Administrator IIM
Gender :
Male
Female
Race :
B - Bumiputera
C - Cina
F - Foreigners
I - India
M - Melayu
O - Lain-lain
X - NOT AVAILABLE
Citizen :
MALAYSIAN
OTHERS
Occupation :
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Mobile Number :
Parents/Guardian Information (For Kids Membership below 12 Years Old Only)
Parent/Guardian's Name :
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Mobile Number :
No IC/Passport No :
Purpose :