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Membership Registration 2017-05-13T18:26:44+00:00

Application For Membership

If you are interested to become a part of us, please fill up the form below to register.

Name(as in NRIC):*
Postal Address:*
Practice Address:*
Qualification(s) & year:*
Category of Practice:*
NRIC / Passport No:*
E-mail:*
Date Of Birth:*
 / 
 / 
Place Of Birth:*
Sex:*
Phone (Mobile):*
Phone (Home):
Phone (Office):
Fax:
Type of membership applied:*
Word Verification:

Once you click the 'Submit' button, you will be redirected to Paypal checkout page for payment session. If you don't have a PayPal account, you can still pay by using your debit or credit card in the checkout page. Please kindly proceed.