EmailMe Form - MEMBERSHIP FORM

CONTACT PARTICULARS

Application for *

New

Renewal

Callsign *

Please write SWL if no callsign

Handle

Calling name

Fullname *

New I/C No *

Old I/C or Passport No *

Nationality *

Date of Birth *

DD / MM / YYYY

Sex *

Male

Female

Profession

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

Office Phone

Mobile Phone *

Email *

Confirm

LICENSE PARTICULARS

Date of Issue

DD / MM / YYYY

Date of Expiry

DD / MM / YYYY

Client ID No

Apparatus Assignment No

INTRODUCER (must be a NESRAC member)

Fullname *

Callsign *

Membership No *

Mobile No *

PAYMENT DETAILS (Please attached proof of payment)

Date of Payment *

DD / MM / YYYY

Transaction Number *

Transaction Method *

Cash Deposit Machine

Maybank2U

GIRO / IBG Transfer

For GIRO / IBG Transfer, please state bank name

Payment :

RM20.00 Registration fee (One-time only for new application)

RM20.00 Yearly Fee for 9M/9W (1-year)

RM60.00 Yearly Fee for 9M/9W (3-years)

RM100.00 Yearly Fee for 9M/9W (5-years)

RM12.00 Yearly Fee for Ordindary/Young member (1-year)

RM36.00 Yearly Fee for Ordindary/Young member (3-years)

RM60.00 Yearly Fee for Ordindary/Young member (5-years)

Proof of payment *

Please upload your proof of payment.

CONFIRMATION

Agreement *

I hereby agree that in the event of my election to membership of NESRAC, will abide by and observe the rules, regulations and articles of the Club.

I further agree to observe strictly the terms of my license issued to me by Malaysian Communications And Multimedia Commission to operate transmitting and receiving apparatus.