Membership Registration Form

Membership Join Form

Membership Username

Membership Password (Used For Membership Login Only)

Title (Prof/Assoc.Prof/Dr/Mr/Ms)

Fullname

Call Name

Email

Work Address (Name of Institution, Address)

Mailing Address

Phone Number (Mobile)

I would like to be included in MAMP WhatsApp group

Yes, I am happy to be included in the WhatApp group to received periodical updates

No, I prefer to be contacted individually by the secretariat

No, I don’t have the WhatApp application

Nationality

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Bachelor/First Degree (Name)

Bachelor/First Degree (University)

Bachelor/First Degree (Year)

Master Degree (Name)

Master Degree (University)

Master Degree (Year)

PhD degree (Name)

PhD degree (University)

PhD degree (Year)

Please state any other formal degrees obtained including university and year

Please upload your academic degree certificate (Bachelor/Master/PhD) on a cloud drive, and provide the link below

Occupation Type

Select Occupation TypeResearch OfficerScience OfficerLecturerStudentOther : Please Specify

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Job Title

Specialisation

SpecialisationRadiotherapyNuclearMedicineDiagnostic RadiologyOther : Please Specify

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Have you registered as Medical Physicist under MAHPC ?

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Please enter your registration number

Membership Type

Select Membership TypeOrdinary Member (RM30/annually)Associate Member (RM20/annually)Upgrade to Lifetime Member (RM300)

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Please Make Sure The Receiver Name Is : Persatuan Fizik Perubatan

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