Registration members


Name :
IC Numbers :
E-mel :
Federal Citizenship Certificate No. :
Date of Birth :
   
Age :
Place of Birth :
Town :
District :
State 
   
Address :
Office Tel :
Mobile Tel :
Work Station :
City :
State :  
Grade :
Qualification
 Click at Check Box
to fields Qualification box
Post Basic
Diploma
  Degree and above
Medical Assistants Registration No. :
(In Accordance with the Medical Assistants (Registration) Act 180, 1977 & Medical Assistants Regulation (Registration)1979 - Revised 1985, A621)
   
   
    agree