FORM NUMBER BALI CULINARY PROFESSIONALS & MEMBER REGISTRATION FORM @ pt Pi sai Cotsay Prokesiran \@artancioaneryerosben com i Registration Category : SUPPLIER & DISTRIBUTOR NEW MEMBER =] RENEWAL oO Fee 1.500.000,- IDR per year Fee 1.500.000,- IDR per year PLEASE WRITE IN CAPITAL LETTERS Company Name Company Address: Company Phone Number... Company Website COMPANY PERSONAL MEMBER Positions Name Date of Birth Phone Number Email Positions. Name Date of Birth Phone Number Email Sign By COMPANY STAMP | Apply for membership and declare the above informations given is correct, im aware and agreed, membership applications only efective upon approved by Board of YCCI Comittee and BCP Commite as mother organizations. Board of BCP Committee The undersigned, Board of committee Bali Culinary Professionals confirms that above candidate fulfils the conditions, for one year active membership period, January - December 2024