ASEAN PUBLIC RELATIONS NETWORK APPLICATION FOR APRN MEMBERSHIP Secretariat : Intiland Tower -‐ Annexe, 8th floor Jl. Jend. Sudirman Kav. 32, Jakarta Pusat 10220 Tel: (62-‐21) 5708143 ext. 12 | Fax: (62-‐21) 2510185 | Hotline: 081513051344 Twitter : ASEAN PR Network (@ASEAN_PR ) Facebook : ASEAN Public Relations Network Instagram : ASEAN Public Relations Network (@aprn) Website : www.aseanprnetwork.org *Fill in by secretariat Membership No. : …………..………… *Fill in with BLOCK letters PERSONAL PARTICULARS Name as in Identity Card / Passport Title : Mr./Ms./Mrs. Given Name : Family Name : Nationality : Date of birth (DD/MM/YY) : ID Number : Gender : Male / Female Home Address : City : State : Country : Home Tel : Mobile: Email : Field of Institution / Company : Educational Background : Payment Status : Cashed Transferred Transfer Date: ……………………………………………………………………………………………………………………………………… Sender Account Number: ……………………………………………………………………………………………………………… CURRENT EMPLOYMENT Company Name : Designation : Company Address : City : State : Country : Office Tel : Email : Fax No : INSTITUTION Institution Name : Position : Institution Address : Office Tel : Fax No : Email : No. Title of Certification / Accreditation Name of Institution Applicable Year hereby apply for admission to the ASEAN PUBLIC RELATIONS NETWORK as a/an : Corporate / Professional (Individual) / Academician / Researcher or Student Applicant, Dated………………. Name & Signature Terms and Conditions for membership a. 2 (two) copy of ID card b. 2 (two) 4x6 passport size photo (color) c. Name Card d. 1 copy of certification/accreditation document Membership Fee Corporate / Institution USD $250 / year Professional/Individual USD $150/year Academician USD $100/year Student USD $50/year MEMBERSHIP CATEGORY 1. Regular membership >> USD $150 Open to all public relations practitioners who are citizens of Indonesia, and/or international citizens in ASEAN environment Regular members must possess certification in the field of public relations issued by an association or certification body from ASEAN countries. 2. Institutional membership >> $ USD250 Open to all educational institutions in Indonesia, and ASEAN countries which are approved and accredited by Indonesian Ministry of Education and Culture or Educational Council in ASEAN Countries. -‐ Government or non-‐government institutions -‐ Formal or non-‐formal educational institutions -‐ Associations in the field of public relations Corporate membership >> USD $250 Open to all PR agencies/consultancies or organizations associated with the practice of Public Relations in ASEAN environment 3. Academic membership >> USD $100 Open to academic with an educational background in the field of public relations 4. Student / Researcher membership >> USD $50 Open to all college or university students who are studying and undergoing research in the field of public relations in Indonesia and other ASEAN countries.