:: MEMBERSHIP APPLICATION FORM >>
	Type of Membership: AFFILIATE MEMBER PROVISIONAL MEMBER ORDINARY MEMBER ASSOCIATE MEMBER FELLOW MEMBER LIFE MEMBER Membership Fee: Affiliate: RM100.00 Provisional: RM100.00 Ordinary: RM100.00 Associate: RM150.00 Fellow: RM200.00 Life Member: RM3,000.00 (1 time payment) Personal Details: * Full Name: * NRIC: * Date of Birth: Gender: MaleFemale Nationality: Race: * Correspondence Address: Post Code: * Tel: (O.) (Hse.) (Cell) (Fax) * E-mail: Company Details: * Date contracted as agent: * Agent's Code: * Position: Full TimePart Time * Company: * Agency: Payment: * Payment Type: Cash Credit Card Cheque
		*Please ensure that you have filled in all the specific fields in order to submit the form. Thank you.
	<< Back