Membership Registration – Malaysian Society of Periodontal

Application For Membership

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

"*" indicates required fields

Username*

Password*

Email*

Name (as in NRIC)*

NRIC / Passport No*

DOB*

Place of birth*

Gender*

Phone (mobile)*

Phone (home)

Phone (office)

Postal Address*

Practice Address*

Qualification(s) & year*

Type of membership applied*

Ordinary (Malaysian with formal post graduates studies in periodontology - RM150 (membership fee rm100+ processing fee rm50))

Associate (Others, who have interest in periodontology - RM130 (membership fee rm80+ processing fee rm50))

Category of Practice:*

Private Practice

Min. of Health

University

General

Others

Category of Practice Others

Proof of Payment*

Accepted file types: jpg, jpeg, png, Max. file size: 2 MB.

Payment can be made via ATM/ online transfer to: PERSATUAN PERIODONTOLOGI MALAYSIA CIMB no: 8001289541

Name

This field is for validation purposes and should be left unchanged.

Kuala Lumpur