Renewal – SEGRM

02 - Renewal

If you are human, leave this field blank.

Membership Details

(Please enter your IC/Passport number and wait until your membership details to be generated automatically)

IC / Passport Number *

Membership Number *

Personal Details

Title

First Name

Last Name

Email Address

Phone Number

Mobile Number

Payment Details

Note: Please upload your bank-in-slip after you had made the payment to our bank account as below.

Bank name :	RHB ISLAMIC BANK BERHAD
Account name :	PERSATUAN KEJURUTERAAN GEOLOGI DAN MEKANIK BATUAN MALAYSIA
Account number :	21245760018819
Branch name :	BANDAR BARU BANGI, SELANGOR

Registration Type *

NEW (RM20.00 Entrance Fee)

RENEWAL

Membership Category *

STUDENT MEMBER (RM50.00)

ORDINARY MEMBER (RM100.00)

CORPORATE MEMBER (RM500.00)

Payment Slip *

Maximum upload size: 1MB

(Format JPG/GIF/PNG/BMP/PDF)

Total Payment (RM) *

Submission

Declaration *

I hereby declare that the details furnished above are true and correct to the best of my knowledge. I shall inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.