Membership Registration

This form can be used for applying for the membership of the VDMS Alumni Association. After completing this form our office in Jakarta will contact you.

Personal
Your name* your full name
Gender*  
Email* The email address where you can be reached
Phone* home phone or cell phone
Birth date*
Address
Home address* address you are living
City*
ZIP code*
Province*
Alumni information
School/university name Name of the school you graduadet
Discipline/Field of study
Grant period Period you received a scholarship from VDMS
Year of graduation
Work
Are you employed? *  
If employed, name employer
If employed, your job title