MEMBERSHIP APPLICATION FORM

I / We wish to apply for membership in the MALAYSIAN INTELLECTUAL PROPERTY ASSOCIATION and submit herewith the following particulars for your kind consideration.

CATEGORY OF MEMBERSHIP

CATEGORY	ENTRANCE FEE	ANNUAL SUBSCRIPTION
ORDINARY : INDIVIDUAL	RM 150.00	RM 200.00
ORDINARY : CORPORATE	RM 300.00	RM 400.00
ASSOCIATE : INDIVIDUAL/CORPORATE	RM 250.00	RM 250.00
YOUNG IP PROFESSIONAL (YIPP)	RM 50.00	RM 100.00
STUDENT	NIL	RM 50.00

MEMBER'S DETAILS

FULL NAME OF PROPOSED MEMBER: [Please underline surname where applicable.]

.

NRIC / COMPANY / BUSINESS REGISTRATION NO:

- / - / -

CORRESPONDENCE ADDRESS:	-

POSTCODE:

TOWN/CITY:

STATE:

TELEPHONE:

MOBILE:

FAX NO :

E-MAIL:

NATIONALITY / COUNTRY OF INCORPORATION:

For CORPORATE MEMBERS,ONLY-provide details of Designated Representative:

FULL NAME:

POSITION:

NRIC NO:

FOR ORDINARY,ASSOCIATE AND YIPP MEMBERS ONLY

FOR YIPP MEMBERS ONLY .         [Please √ if applicable to the Proposed Member]

FOR STUDENT MEMBERS ONLY

NAME OF COLLEGE / UNIVERSITY:

QUALIFICATION / COURSE BEING PURSUED:

FACULTY:

TOWN/CITY:

PROPOSER DETAILS

This application for membership is proposed and seconded by two (2) existing Ordinary members in benefit whose particulars are as follows:
Proposed by:	Seconded by: