Membership fee is either:

• Ordinary membership: RM50.00 per year, or
• Life membership: RM400.00 (one time payment)

* - indicates required information

* Full name (please include title: e.g., Prof., Dr., Mr., Ms.):

* Official address:

* Tel:

* Email:

* Private address:

* Date and place of birth:

* Citizenship:

Public honours/decorations:

* Education (university/college, degrees/diploma with class of honours with dates):
1.
2.
3.
4.

* Present employment
(nature of appointment and name of employer):

Members of professional bodies:
1.
2.
3.
4.

Any additional information: