Please print and complete this form together with the entrance and annual membership fee payable to " The Malaysian Invention And Design Society " or " MINDS" and send it to Hon. Secretary at MINDS, Damansara Intan C3A-10, 4th Floor, Block C, No. 1, Jalan SS 20/27, 47400 Petaling Jaya, Selangor, Malaysia.

Tel +603 7118 2062 Fax+603 7118 2063 Email TSO@minds.org.my Website www.minds.org.my

Section A

Name :
I.C no (New) :
Address :
   
Telephone :
Fax :
Handphone :
Email :
Date of birth :
Place of birth :
Sex : Female / Male
Marital Status :
Qualification :
Present Occupation :
Company Name :

For Corporate Member :-

Nominee :
Position in the company :

Parental of Guardian Consent (if applicant is under 18 years old)

Date :
Signature :

Declaration by applicant

I declare that the particulars given above are correct, and if elected, agree to abide by the conditions, rules and regulation of the society.

Date :
Signature :

Section B

Field of Interest

  • Please tick where applicable.
  • You may tick more than one field.
 
Interest
Invention
Industrial Design
Patent / Intellectual Property
Engineering
Venture Capital / Investment
Prototyping / Entrepreneur
Computer Hardware
Electronics
Computer Software / Multimedia
Publication
Education / Students
Talks / Seminars
International Liaison
Others (please specify) :  

Section C

I was introduced to MINDS by

Membership no. :

 

Individual Member RM 100 (Entrance Fee) + RM 50 ( Annual Fee ) = Total RM 150
Corporate Member RM 1,000 (Entrance Fee) + RM 300(Annual Fee) = Total RM 1,300

 

 

For Office Use only

Date Received :     Date considered / approved :    
Paid (RM) : cash / money order     Date informed :    
cheque no. :     Ref :    
Receipt no. :     Membership no. :    
Date referred :