IHGM Office Hotel Trinity Jalan Pembangunan 3 No.

4 Phone: [62 21 633 1111]

READ THIS FIRST Purpose of this form

This form is an application to join IHGM, a Non formal organization for General Manager/Resident Manager who currently active in Indonesia. The Registration is Voluntary WHICH HOTELs GM/RM MAY APPLY FOR REGISTRATION? All active General Managers/Resident Managers from 3-5 star hotel in Indonesia with minimum inventory of 70 rooms and above are welcome to join WHO FILLS IN THIS FORM? The individual General Manager/Resident Manager who wish to join WHERE DOES THIS FORM SHOULD BE SUBMITTED? IHGM Membership & Media Division Attention: Bustamar Koto gmjakarta@acacia-hotel.com Bustamar.koto@acacia-hotel.com or I Gede Wahyu Gm.bsd@grandzuri.com WHAT IS THE YEARLY CONTRIBUTION FEE Every member required to contribute Rp. 1.000.000/person yearly. WHERE TO TRANSFER Account Name: Andyani Noeriman - IHGM Bank Mandiri Acc No 126-00-0641748-8 Please email the copy of transfer payment to IHGM - Treasury Division Andyani Noeriman IHGM Andyani.noeriman@gmail.com SPONSORING MEMBER 2nd man (RM/EAM) in organization may join the IHGM subject to their General Manager approval HONORARY MEMBERS IHGM by committee approval may invite Non General Managers to join IHGM due to their important role being in the organization

APPLICATION FOR REGISTRATION INDONESIA HOTEL GENERAL MANAGER (IHGM)

Name ID Number Hotel Name Hotel group Hotel Address City Postal Code Tel Mobile Fax E-mail Website PIN BB Facebook Twitter : __________________________________________________ : __________________________________________________ : __________________________________________________ : (if available)________________________________________ : __________________________________________________ : __________________________________________________ : __________________________________________________ : (62)________________________ : (62)________________________ : (62)________________________ : ___________________________ : ___________________________ : (if any)______________________ : (if any)______________________ : (if any)______________________

Your hotel rating (a)3 star (b) 4 star

(c) 5 star : :

(d) boutique non rated rooms years

Your hotel room inventory Years of service in hotel industry

DECLARATION BY PERSON SUBMITTING THIS APPLICATION I, the undersigned, declare that I am duly authorized in my hotel to complete and submit this application and that the information contained in this form is to the best of my knowledge correct.

Name Position Signature Date

: ___________________________ : ___________________________ : ___________________________ : ___________________________

*The successful of the registration is subject to IHGMs committee approval. Yearly contribution should be submitted upon confirmation from IHGM not later than 1 month after the confirmation being received * Honorary members contribution fee: Supplier Rp. 10.000.000/person, Hotel owner Rp. 5.000.000/person yearly