» Membership

Application for Ordinary member

1. Category (please tick one only)

(please tick one only) (required)

Individual

Organisation

(please tick one only) (required)

Practitioner/Praktisi: certification bodies, consultants, assessors

Producer

Observer/Pemerhati: Environmental NGOs, Social NGOs, communities, academicians

2. Identity of the Individual or Organisation (please print or type)

For Individual Category

Nama (required)

Profession (required)

Address (required)

Telephone (required)

Fax (required)

E-Mail (required)

Website

For Organisation category

Name of organisation (required)

Address (required)

Telephone (required)

Fax (required)

E-Mail (required)

Website

3. Organisation category only:

Nomination of Representative(s) (please provide details of one or two representatives). Application should be endorsed and signed by a senior member of the organisation who will take responsibility for ensuring the organisation conforms to the HCV Network Indonesia Statutes and by-laws.

Primary Representative

Name

Designation / position

Telephone

Fax

E-Mail

Secondary Representative

Name

Designation / position

Telephone

Fax

E-Mail

4. Application for membership is made by

Upload Signature (required)

Browse...

Maximum size 10MB

Name (required)

Designation / position (required)

Date (required)

5. Please return this form to:

HCV Network Indonesia
Jend. A. Yani street no. 68J, Tanah Sareal, Bogor 16161
West Java, Indonesia
Telp: +62-251-831-6156
Fax: +62-251-831-6257
Email: info@hcv-ni.org

Transition contact person:
1. Kresno Santosa, +62-852-4726-2609
2. Wahyu F. Riva, +62-812-9956-720

Should you have further enquiries, please e-mail or contact us.

Type the characters (required)

This field should be left blank

Please wait...

Application for Ordinary member

© 2015 HCV | Network Indonesia.

Top ↑

Follow us:     

Application for Ordinary member

© 2015 HCV | Network Indonesia.

Top ↑

Follow us:     

Facebook