Registration members
Name
:
IC Numbers
:
E-mel
:
Home Address
:
Office Tel
:
Mobile Tel
:
Place of Work
:
City
:
State
:
Johor
Kedah
Kelantan
WPKuala Lumpur
WPLabuan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
WPPutrajaya
Sabah
Sarawak
Selangor
Terengganu
Grade
:
Medical Assistants Registration No.
:
(In Accordance with the Medical Assistants (Registration) Act 180, 1977 & Medical Assistants Regulation (Registration)1979 - Revised 1985, A621)
I agree if admitted, to abide by Association's Rule and Constitution and such ammendments as may from time to time made in them.
agree