MEMBERSHIP APPLICATION FORM (Normal Individual Membership only)

I wish to apply to become a member of the Malaysian Evaluation Society.  Please register me:

Note: For all other membership categories, please contact the MES Secretariat at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Full Name:  …………….……………………………………………………………………………………………………………………………………………………………………………………

National ID Card No.:  New: ……………—……—……………                              Age: ……………………………………

Office Address:  ……………………………………………………………………………………………………………………………………………………………………………………………

Home Address:  ……………………………………………………………………………………………………………………………………………………………………………………………

Telephone (office) : …………………………………………                                                        Fax (office):……………………………………………………………

Telephone (home) : …………………………………………                                                        E-Mail: ……………………………………………………………………

Academic Qualifiaction:

Diploma: ………………………………………………………………………………………………………………………………………………………………………………………………………

Basic Degree: …………………………………………                                                                Masters: ……………………………………………………………………

Ph.D. & Specialization: …………………………………………………………………………………………………………………………………………………………… ……………………

Professional Qualifications:

(i) ……………………………………………………………………………………………………………………………………………………………………………………… ………………………

(ii)  …………………………………………………………………………………………………………………………………………………………………………………………………… ………

Present Position: ….………………………………………………………………………………………………………………………………………………………………………………………
.
Agency’s Name:  ……………………………………………………………………………………………………………………………………………………………………………… …………

Information about present position and work: ………………………………………………………………………………………………………………………………………………

Please provide some infor on how you are involved with evaluation.

…...………………………………………………………………………………………………………………………

Attached herewith is a cheque/bank draft/LPO being the registration fees of RM__________________

…………………………………………                                                    ……………………………
(Signature)                                                                                          (Date)

• Please return this completed version by post, fax, or by email and include the appropriate payment.
• The MES Committee reserves the right to reject an application.  In the event of such rejection, the payment received will be returned to the applicant.

_______________________________________________________________________________________________________________________

Date Received: ………………………………                                                   Payment Received:  RM …………………

Date Approved:  ……………………………………                                                   Receipt No.: ………………………………

Membership No:     ………………………………                                                                                                                                                                                                                                
Receiving Person:  ……………………………………………………………....…                  Signature:……………………………

Download: English Version OR          BM Version