Malaysian Society of Allergy & Immunology (MSAI)

Join MSAI

I hereby apply for membership as:

Title:

Name:

Specialty:

Qualifications:

Position:

Place of Practice:

Postal Address:

Postcode:

State:

Tel No:

Fax No:

Mobile No:

E-mail:

Referee 1:

Email:

Referee 2:

Email:

*Ordinary Member (Entrance Fee RM 100 + RM 50 Subscription Fee)

*Life Member (Entrance Fee RM 1000 One-time payment)

*Associate (Entrance Fee RM 100 + RM 50 Subscription Fee)

Attached is a scanned copy of the proof of payment: (Image or pdf file - limit to max 2 MB file size)

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT.
I CERTIFY THAT I HAVE READ THE RULES OF THE SOCIETY AND PRIVATE POLICY.

I AGREE THAT THE INFORMATION (NAME, SPECIALTY, PLACE OF PRACTICE, STATE, TEL NO, AND E-MAIL) MAY BE SEARCHED AND VIEWED BY THE PUBLIC.