REGISTRATION FORM

I. GENERAL

Please fill-in this application form and email completed PDF Form to:
sekretariatmaskeei@gmail.com or WhatsApp to number: +62895-3926-18483 (Dini)

Upon approval, MASKEEI secretariat will send an official Invoice for the membership fee to the email address provided in the Candidate Information Section. Payment information will be provided in the invoice.

For inquiries regarding membership, please contact MASKEEI secretariat below:
Sekretariat Masyarakat Konservasi dan Efisiensi Energi Indonesia (MASKEEI): Plaza Asia Building 16th floor suite 16C
Jl. Jend. Sudirman Kav. 59 Jakarta.
Phone: +6221-51401546/+62895-3926-18483. Attention: Dini.


II. REGISTRATION INFORMATION

IIA. CANDIDATE

Please provide your information below. All line marked with an asterisk (*) are mandatory


IIB. MEMBERSHIP CATEGORY

Please select ONE of the membership category below by ticking with appropriate check boxes (tick only one of those)
1. Individual
Registration Fee (Rp.500.000)Annual Renewal Fee (Rp.500.000)
2. Profesional Association
Registration Fee (Rp.1.000.000)Annual Renewal Fee (Rp.1.000.000)
3. Business Association
Registration Fee (Rp.10.000.000)Annual Renewal Fee (Rp.1.500.000)
4. Company/Organization
Registration Fee (Rp.5.000.000)Annual Renewal Fee (Rp.1.500.000)
5. Non-resident Foreign Individual
Registration Fee (USD.150)Annual Renewal Fee (USD.100)
6. Foreign Company/Organization without base/rep office in Indonesia
Registration Fee (USD.1000)Annual Renewal Fee (USD.250)
7. Students
Registration Fee (Rp.250.000)Annual Renewal Fee (Rp.250.000)


III. ACKNOWLEDGEMENTS

Please acknowledge the statements below by ticking the check boxes:
I understand that the information supplied herewith are true, current and accurate to the best of my knowledge. I understand that providing false information will result in revocation of membership without prejudice and without any refunds to already paid membership fees.I understand that MASKEEI member benefits are subject to change and that MASKEEI reserves the right to make such changes in order to improve membership experience and allow MASKEEI to further the Energy Conservation and Efficiency endeavors.


IV. AGREEMENT & SIGNATURE

I/We, hereby, would like to apply for membership of the Indonesian Energy Conservation and Efficiency Society (IECES/MASKEEI) and agree to pay the Membership Fee according to the specific category of membership via Bank Transfer to:
Bank Woori Saudara - Account No: 200.20000.7205 - Beneficiary Name: MASKEEI (proof attached)

Date:
Signature (Just simply write down your initial name as your signature above):