WOMEN ENTREPRENEURS & PROFESSIONAL ASSOCIATION SARAWAK.

Is a non-government organization (NGO) which was registered with the Registrar of Societies on 4 th November 1996
Contact : PO Box 1162, 98008 Miri. Email : wepsmiri@hotmail.com

MEMBERSHIP APPLICATION FORM

PHOTO

PERSONAL DETAILS

NAME

NRIC NO NATIONALITY:

DATE OF BIRTH PLACE OF BIRTH :

MARITAL STATUS NO. OF CHILDREN :

QUALIFICATION

YEAR OBTAINED

PLACE

RESIDENTIAL ADDRESS

TEL NO FAX NO :

EMAIL ADDRESS

NAME OF SPOUSE

SPOUSE OCCUPATION &

COMPANY
AGE :

NAME OF CHILDREN
BUSINESS DETAILS

NAME OF COMPANY

TYPE OF BUSINESS

POSITION

OFFICE ADDRESS

TEL & FAX NO

EMAIL ADDRESS

ARE YOU A MEMBER OF OTHER ORGANISATION?

NAME OF NATURE OF ORGANISATION POSITION CURRENTLY HELD
ORGANISATION

WHAT IS YOUR MAIN REASONS FOR JOINING THIS ORGANISATION?

WHAT ARE YOUR PERSONAL INTEREST, HOBBIES?

MEMBERSHIP FEES AMOUNT Pls tick

ENTRANCE FEE (Compulsory) RM30.00

ORDINARY MEMBERSHIP & Annual Subscription RM60.00
LIFE MEMBERSHIP RM1,000.00
TOTAL RM
MODE OF PAYMENT : CASH/ CHEQUE /ONLINE are acceptable.
BANK : ALLIANCE BANK MALAYSIA BHD
NO : 11027-00100-04796

……………………………… DATE : ……………………..

APPLICANT SIGNATURE

FOR WEPS INTERNAL USE

PROPOSED BY SECONDED BY APPROVAL

…………………………….….. ……………………………….. ……………………………

NAME : NAME : PRESIDENT
DATE :