Registration members

Name	:
IC Numbers	:
E-mel	:
Federal Citizenship Certificate No.	:
Date of Birth	:
		Age :
Place of Birth	:	Town : District : State  :  Johor Kedah Kelantan WPKuala Lumpur WPLabuan Melaka Negeri Sembilan Pahang Perak Perlis Pulau Pinang WPPutrajaya Sabah Sarawak Selangor Terengganu
Home Address	:
Office Tel	:
Mobile Tel	:
Place of Work	:
City	:
State	:	Johor Kedah Kelantan WPKuala Lumpur WPLabuan Melaka Negeri Sembilan Pahang Perak Perlis Pulau Pinang WPPutrajaya Sabah Sarawak Selangor Terengganu
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)
		I agree if admitted, to abide by Association's Rule and Constitution and such ammendments as may from time to time made in them.
		agree