Membership Form

I hereby would like to renew my membership of the Malaysian Association for the Advancement of Functional and Interdisciplinary Medicine as an Ordinary Member and shall abide by its Rules and Regulations.

I also remit my first Annual Dues. ( Please forward your banking slip also to whatsapp https://wa.me/60123702118 or email info@maafim.org)

Email address *

Full Name as in NRIC / PASSPORT *

Full Name as in NRIC/Passport

Title: *

Dr. Mr, Mrs. etc

Designation / Vocation *

Residential Address *

PostCode *

City *

Mailing Address *

PostCode *

City *

Qualifications

University

Office Address *

PostCode *

City *

Membership Fee Details

Annual Fee Renewal RM100.00
Total Payable RM100.00

Phone