IIHA Membership Form

 
Indonesian Industrial Hygiene Association (IIHA) is an association established on 12 January 2016 as a non-governmental organization (NGO) and a non-profit organization that aims to improve high professional standards for its members to be able to compete internationally in the field of Industrial Hygiene. IIHA is an organization consisting of Indonesian industrial hygiene experts working in all industrial sectors spread all over Indonesia from Sabang to Merauke.
 
Please read carefully and fill the form completely
In order to collect both old and new members of IIHA, please fill out the form below. For those of you who have filled out similar forms, please fill out the form below. Before filling out the form, please prepare:
  • Your photo
  • Previous IIHA member card; if you already a member
  • Student card; if you are a student
Format file: jpeg, jpg, png, doc, docx Maximum file size each item 500kb Investment:
  • 3 years membership: IDR 500.000,-
  • 1 year membership: IDR 250.000,-
  • Student membership (only for 1 year): IDR 100.000,-
For further info:
  • Website: www.iiha.id
  • Email: email.iiha@gmail.com
IIHA Admin:
  • Mahmuda Soraya (+62 858 1502 1821)
  • Stevan Sunarno (+62 812 819 6559)

Personal Information

Title*
  • - select your title -
  • Mr.
  • Mis.
Username*
First Name*
Birth Place*
Password*
Last Name*
Birthday*
Address*
Mobile Phone*
  • - select your country -
  • Åland Islands
  • Afghanistan
  • Albania
  • Algeria
  • American Samoa (US)
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda (UK)
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei
  • Bulgaria
  • Burkina Faso
  • Burma (Myanmar)
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo, Democratic Republic of the
  • Congo, Republic of the
  • Cook Islands (NZ)
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • East Timor (Timor-Leste)
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands (UK)
  • Faroe Islands (Denmark)
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia (France)
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar (UK)
  • Greece
  • Greenland (Denmark)
  • Grenada
  • Guam (US)
  • Guatemala
  • Guernsey (UK)
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hong Kong (China)
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran
  • Iraq
  • Ireland
  • Isle of Man (UK)
  • Israel
  • Italy
  • Ivory Coast
  • Jamaica
  • Japan
  • Jersey (UK)
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea, North
  • Korea, South
  • Kosovo
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macau (China)
  • Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mayotte (France)
  • Mexico
  • Micronesia, Federated States of
  • Moldova
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Caledonia (France)
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue (NZ)
  • Norfolk Island (Australia)
  • Northern Mariana Islands (US)
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn Islands (UK)
  • Poland
  • Portugal
  • Qatar
  • Réunion (France)
  • Romania
  • Russian Federation
  • Rwanda
  • São Tomé and Príncipe
  • Saint Helena, Ascension and Tristan da Cunha (UK)
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon (France)
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen (Norway)
  • Swaziland
  • Sweden
  • Switzerland
  • Syria
  • Taiwan
  • Tajikistan
  • Tanzania
  • Thailand
  • Togo
  • Tokelau (NZ)
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Vatican City
  • Venezuela
  • Vietnam
  • Wallis and Futuna (France)
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe
Email*

Membership Options*

Select your chosen membership type

Educational Background

Fill with "NA" if not applicable for you
Diploma Majors*
Master Majors*
Bachelor Majors*
Doctorate Majors*

Job and Experience Background

Fill with "NA" if not applicable for you
Company/Institution/Organization*
Experience in Industrial Hygiene since*
Position*
Certificate in Industrial Hygiene*

Document Upload

Photo File*
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Previous IIHA member card
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Student card
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Indonesian Industrial Hygiene Association (IIHA)

C Building 1st Floor
Occupational Health & Safety
Department Faculty of Public Health
University of Indonesia
Depok – West Java
16424
Indonesia

website: https://www.iiha.id
Email : email.iiha@gmail.com
Phone : +62-21-78849033, +62-21-7863487

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Copyright © 2019 IIHA – Indonesian Industrial Hygiene Association