INDIVIDU

1. Nama Lengkap | Full Name *

2. Pekerjaan | Occupation *

3. Nomor HP | Cellphone Number *

4. Alamat Email | Email Address *

5. Alamat Surat | Mailing Address

Kota | City

Propinsi | State/Province

Kode Pos | Postal Code

CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe

DATA PERUSAHAAN | COMPANY DETAIL

6. Nama Perusahaan | Company Name

7. Alamat Kantor | Business Address

Kota | City

Propinsi | State/Province

Kode Pos | Postal Code

CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwe

8. Saya mendaftarkan diri untuk KEANGGOTAAN PERSEORANGAN & SETUJU untuk mengikuti semua ketentuan AD/ART Masyarakat Uji Tanpa Rusak Indonesia (MUTRI) *Setuju | AgreeI hereby apply for INDIVIDUAL MEMBERSHIP of Indonesian Society for Non Destructive Testing (MUTRI) and agree to cpmply with the AUTRI Charter

9. Pembayaran dengan transfer | Payment by bank transfer to BANK MANDIRI, Jakarta Sudirman Branch, Indonesia - Account No. 1020000111556, Account Name: Masyarakat Uji Tanpa Rusak Indonesia *1 Tahun | 1 Year : Rp. 100.000

10. Mohon melampirkan bukti transfer | Please attach your payment receipt

Choose FileNo file chosenDelete uploaded file

Bukti transfer bisa dikirim melalui WA | Payment receipt can be sent by WA: +62 811 847 6900

PROFIL ANGGOTA | MEMBERSHIP PROFILE

11. Tanggal Lahir | Date of Birth *

12. Jenis Kelamin | Gender *Wanita | FemalePria | Male

13. Jenjang Pendidikan | Highest Educational LevelSMA/SMK | Senior High SchoolDiploma | CollegeStrata-1 | First GraduatesStrata-2 | Master's DegreeStrata-3 | Doctoral Degree

14. Pengalaman di Bidang UTR | Years of Experience in NDT0 - 56 - 1011 - 1516 - 2021 & over

15. Tugas Pokok & Fungsi | Your Job Function *Manajemen UTR | NDT ManagementManajemen Mutu | Quality ManagementEnjinir | EngineerTeknisi/Inspektor | Technician/InspectorKonsultan | ConsultantPenjualan/Pemasaran | Sales/MarketingPeneliti | ResearcherAkademisi | Academic/EducatorInstruktur | Trainer/InstructorMahasiswa | Student

16. Tanggung jawab pembelian | Purchasing responsibilitySaya menyetujui pembelian peralatan/instrument/pasokan | I recommend/approve purchase of equipment/instrument/suppliesSaya menyetujui pelatihan & kursus material/program | I recommend/approve purchase of training & study materials/programsSaya merekomendasi pengadaan jasa | I recommend purchase of servicesPilih satu atau lebih | Select all that apply

17. Metode NDT yang digunakan oleh Perusahaan Anda | Which NDT methods does your company workAcoustic EmissionAlternating CurrentEddy CurrentGround Penetrating RadarInfrared & ThermalLaserLeakLiquid PenetrantMagnetic Flux LeakageNeutron RadiographyRadiographyUltrasonicVibration AnalysisVisualPilih satu atau lebih | Select all that apply

Perusahaan Anda bergerak di sektor industri | Business industry segment that best describe your company

18. Pemanfaatan UTR | NDT Utilization BusinessPesawat Terbang | Aerospace/Aviation/AircraftOtomotif | AutomotiveKimia, Minyak & Gas | Chemical & PetroleumKonstruksi | ConstructionLaboratorium | Commercial LabInfrastruktur (Jembatan & Jalan) | Infrastructure (Roads & Bridges)Elektronika | ElectronicsKelautan | MarineKesehatan | MedicalNuklir | NuclearPerpipaan | PipelineKertas & Pulp | Pulp & PaperKereta Api | RailroadSemikonduktor | SemiconductorUtilitas | UtilitiesPilih salah satu | Select one only

19. Pemasok UTR | NDT Supplies BusinessKonsultasi | ConsultingDistributor | Distributor/Manufacture's RepresentativePeralatan | EquipmentPenelitian | ResearcherSupplies | SuppliesPelatihan | TrainingPilih satu atau lebih | Select all that apply

20. Jenis pemanfaatan UTR yang utama di perusahaan anda | The primary type of application of NDT that your company doesDesign and Failure AnalysisField InspectionIn-service, Plant/Operation Maintenance & Process ControlProduct Life ExtensionQA/QC ReliabilityNone of the abovePilih salah satu | Select one only

21. Kualifikasi UTR Level Tertinggi | Highest Level of NDT QualificationNoneLevel 1Level 2Level 3

Kirim | Submit