Membership Application Form

Application type

Membership category *

Ordinary Member / Ahli Biasa

Associate Member / Ahli Bersekutu

Teenage member (under 18) / Ahli Remaja

National Identity Number *

Country of Residence *

Country of Nationality *

Member Application Type *

Corporation / Institution

Individual

Academic

Student

Applicant - Personal data

First Name *

Last Name *

Mobile number (WhatsApp / WeChat) *

Email *

LinkedIn Profile

Job title *

Note:

All official correspondence such as (but not limited to) membership information, AGM notification and other updates will be sent via email.
Applicant will be considered to be the primary nominated representative of corporate or institution member. A 'nominated representative' means a director or employee from within the corporation or institution appointed by the Owners to represent their interest in the Association.

Organisation

Organisation name

Organisation Registration Number

Address

Street Address *

City

State

Country

Short description of your Product/ Services/ Solution offered

Organisation website

Certificate of Incorporated OR Business Registration Certificate

Introducer

Name of introducer *

Membership Application vouched by *

Proposing Member
Seconding member

Second nominated representative

(only applicable to corporate and institutional members)

First Name of second nominee

Surname of second nominee

Email of second nominee

Mobile number (Whatsapp / Wechat) of second nominee

Statement of Commitment

I am willing to attend a 1-hour online monthly meeting for members. *

Yes

No

I am willing to contribute to the promotion and marketing of the community. *

Yes

No

I am willing to arrange activities for the community. *

Yes

No

I am willing to participate in specific task forces or projects. *

Yes

No

I am willing to contribute to finances needed by the community e.g. donations, sponsorship. *

Yes

No

We hereby confirm that we have the authority to submit this form and apply to become a Member of Circular Business Association (Persatuan Perniagaan Ekonomi Kitaran Malaysia). If admitted, we agree to abide by the Constitution and Regulations of this Association and make timely payments of annual fees. We certify the foregoing information is true and complete and fully realise that omission or falsification of information will be considered sufficient reason for rejection of this application or for dismissal.

We agree to attend a video call with the Association, when requested, as part of the membership application process and for our data to be used for communication from and with Circular Business Association.