Pendaftaran IAGI ProfessionalStudentFull Name*Sex*MaleFemaleDate of Birth* Place of Birth*CitizenshipHome Address*City*Postal Code*Please enter a value between 10000 and 99999.Phone 1*Phone 2Email*Work Organization*Mining IndustryOil/Gas IndustryEducationGovermentCompany/Institution*Position*Division*Address*City*Postal Code*Phone*Education*From (Dates)To (Dates)College/University (Add Address)Indicate Major Field of StudyDegree Received (Give Address) Specialist Expert* After completing this form please send the registration fee dues for student (Rp.100.000/year) or Professional (Rp.250.000/year), payable using bank transfer with the following address : Akun Bank IAGI Bank Mandiri, Jakarta, Indonesia Nama : Ikatan Ahli Geologi Indonesia Nomor : 123 0085 005314 Please send the evidence transfer and your colour picture (2x3) to iagisek@cbn.net.id
