Membership Form

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 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

Life Time Fee RM1000.00
Total Payable RM1000.00