I hereby apply to be a Life Member of the Malaysian Association for the Advancement of Functional and Interdisciplinary Medicine and shall abide by its Rules and Regulations.
I also remit my first Annual Dues of RM1000.00 ( Please forward your banking slip also to whatsapp or email
Full Name as in NRIC/Passport
Dr. Mr, Mrs. etc
Life Time Fee RM1000.00
Total Payable RM1000.00