MEMBERSHIP REGISTRATION FORM

Please complete the form below with accurate and complete information. The information provided will be used for administrative and communication purposes related to this event. All data will be kept confidential and will not be shared with any third party without your consent.
Telepon Perusahaan (Company Phone Number)
Opsional — tuliskan tidak ada jika tidak memiliki website. “Optional — write ‘Not available’ if there is no website
No. HP Direktur Utama. President Director Phone Number.
Email PIC (penerima informasi & permintaan data). PIC email (for receiving information and data requests).
Nama PIC Perusahaan. Company Representative Name.
Jabatan PIC. Contact Person’s Job Title.
No. HP PIC. Company Representative Phone Number.
Email PIC. Company Representative Email.
Kurs USD 16.000
Yang terpasang (Installed)
Yang terpakai (used)
Lokal (Domestic)
Ekspor (Export)
Negara Tujuan (Destination Country)
Kategori Produk Yang Dijual (Product Categories Sold)
Pilih semua yang sesuai (Select all that apply)
Pernyataan dan Kesanggupan (Declaration and Undertaking)
Dengan mengetik nama lengkap, Anda dianggap telah menyetujui Pernyataan dan Kesanggupan di atas. (By typing your full name, you are deemed to have agreed to the Declaration and Undertaking above).