Membership Form Membership Form Step 1 of 2 50% Official form. Your data and details are protected by law. Note: Please fill all sections. Incomplete forms will be automatically rejected. * Kindly submit a certified true copy of certificate/ diploma/ degree in complementary therapy(s) and or alternative medicine. This is for our records.Please tick category of Membership(Required) LIFE EXPATRIATE ORDINARY PRACTISING MEMBER ASSOCIATE MEMBER PERSONAL DETAILSPHOTO(Required)Accepted file types: jpg, jpeg, png, gif.NAME(Required) First DATE OF BIRTH(Required) MM slash DD slash YYYY I.C. NO. (for Malaysian Citizen only)PASSPORT NO. NATIONALITY(Required) MARITAL STATUS Single Married Other RESIDENTIAL ADDRESS(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country CONTACT NO.(Required)(mobile)EMAIL(Required) OCCUPATION(Required) NAME & ADDRESS OF EMPLOYER(Required) QUALIFICATION DETAILSPLACE OF PRACTISE(Required)QUALIFICATION(Required)YEAR OF GRADUATION(Required) INSTITUTION(Required)TYPE OF PRACTISE(Required)FORMAL EDUCATION(Required)A certified true copy of certificate/ diploma/ degree in complementary therapy(s) and or alternative medicine. Drop files here or Select files Max. file size: 100 MB. Note: Please ensure that your Proposer and Seconder hold valid Society MembershipsNAME OF PROPOSE / MEMBERSHIP NO.(Required)NAME OF SECONDER / MEMBERSHIP NO.I understand and agree that the Annual Subscription is payable yearly and in advance or by 1st January each year. A certified True Copy of my Identification Card and/ or valid Passport, and Academic Qualifications are also enclosed for your perusal and records. Thank you for considering my Membership Application to your Society.(Required) Agreed Type of application(Required) New Membership Application Annual Subscription The entrance fee and subscription payable shall be as follows:- Founder Ordinary Practicing Expatriate Associate Life Entrance Fee RM100 RM200 RM1000 RM200 RM1500 Annual Subscription RM100 RM150 RM500 RM150 NIL Honorary Members shall be excluded from payments of subscriptions.
