www.LordmanAlliance.com

mEMBERSHIP FORM

You can now register membership online! Please complete the required details and submit the form below.


Title/Salutation:
Full Name (NRIC):
Alternative Name:
NRIC / Passport No:
Correspondence Address:

Telephone:
Fax:
Email Address:

Please Check Your Business Nature:	Import / Export Manufacturing IT / Computers / Telecommunications Media / Publishing Construction / Engineering Education / Academic Wholesale Retail Shop / Chain / Department Store Management / Consultancy Trade / Distribution Other business (please specify):

Note:	I undertake to abide by the code of conduct of Lordman Alliance in applying to join as a Business Associate. I hereby declare that all information stated in this form is correct and acknowledge that the business associate named above is my introducer.

Terms and Conditions:

Information provided must be exact and correctly filled in.
Kindly enclose photocopy of I/C or Passport; together with payment for Registration Fee of RM100 and Annual Fee of RM200, payable to “LORDMAN ALLIANCE SDN. BHD.”