Membership Registration

Company Membership Dues

Rp 200.000.000,00-/year

(January – December)

Note: (*) is required.

Producing or Non Producing

Producing

Non - Producing

Name of Company / Institution*

Application Letter *

Note: Please upload the signed application letter.
If there is any hard copy, please send it to the IPA Secretariat Office separately.

Company Category

Business Address *

Telephone Number *

Faximile Number *

Name of Representative *

Representative Phone Number *

Alternative Company Representative

Alternative Company Email Address

Email *

Alternative Email Address

Password *

Password Confirmation *

Associate Membership Dues

Rp 13.500.000,00-/year

(January – December)

Note: (*) is required.

Name of Company / Institution*

Nature of Businness

Application Letter *

Note: Please upload the signed application letter.
If there is any hard copy, please send it to the IPA Secretariat Office separately.

Company Category

Business Address *

Telephone Number *

Faximile Number *

Name of Representative *

Representative Phone Number *

Email *

Alternate Associate Representative

Alternate Associate Representative Email

Company Reference

Password *

Password Confirmation *

Individual Membership Dues

Rp 250.000,00-/year

(January – December)

Note: (*) is required.

Salutation

First Name *

Last Name

Job Title *

Company *

Department

Nationality *

Correspondence Address *

Postal Code

Mobile *

Email *

Password *

Password Confirmation *

Student Membership Dues

Rp 100.000,00-/year

(January – December)

Note: (*) is required.

Salutation *

First Name *

Last Name

Department

Faculty *

University *

Nationality *

Address *

Postal Code

Mobile *

Email *

Password *

Password Confirmation *

Student Card ID *

Company Membership Dues

Rp 200.000.000,00-/year

Rp 65.000.000,00-/year

(January – December)

Associate Membership Dues

Rp 13.500.000,00-/year

Rp 0,00-/year

(January – December)

Individual Membership Dues

Rp 250.000,00-/year

Rp 0,00-/year

(January – December)

Student Membership Dues

Rp 100.000,00-/year

Rp 0,00-/year

(January – December)