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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)
Full Name as in NRIC/Passport
Dr. Mr, Mrs. etc
Life Time Fee RM1000.00
Total Payable RM1000.00