Renewal – SEGRM

02 - Renewal [TOYYIB]

Membership Details

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

IC / Passport Number *

(Format: 751211-12-3456)

Membership Number *

Personal Details

Title

First Name

Last Name

Email Address

Phone Number

Mobile Number

Address

(Please check the address correctly)

Membership Affiliation

Please choose one only for international membership affiliation (FREE):

International Society for Rock Mechanics (ISRM)

International Association for Engineering Geology and Environment (IAEG)

Email us at info@segrm.org if you’re interested in paying an extra RM50/year for additional affiliation.

Payment Details

(Payment link will be send to your email address)

Membership Category

STUDENT MEMBER (RM50.00)

ORDINARY MEMBER (RM100.00)

Total

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.

If you are human, leave this field blank.