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 WhatsApp group to receive periodical updates

No, I prefer to be contacted individually by the secretariat

No, I don’t have the WhatsApp application

Nationality

Select NationalityMalaysianOthers : Please Specify

Enter Your Nationality

MyKad (IC) Number

Passport Number

Date of Birth

Place of Birth

Home Address

Under the MAMP Constitution, Ordinary and Life membership is for Malaysian citizens only. Non-Malaysian applicants are welcome to join as an Associate Member.

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 TypePhysicist (Hospital/Clinic)Research OfficerScience OfficerLecturerStudentRegulatory / Enforcement OfficerIndustry (Medical Physics-related company)Other : Please Specify

Enter Your Occupation Type

Job Title

Specialisation

SpecialisationRadiotherapyNuclear MedicineDiagnostic RadiologyRadiation ProtectionOther : Please Specify

Enter Your Specialisation

Have you registered as Medical Physicist under MAHPC ?

Please SelectYESNO

Please enter your registration number

Proposer and Seconder
Under Fasal 4 of the MAMP Constitution, every application must be proposed and seconded by two current MAMP members.

Proposer: Full Name

Proposer: Email

Proposer: MAMP Membership No.

Seconder: Full Name

Seconder: Email

Seconder: MAMP Membership No.

Membership Type

Select Membership TypeOrdinary Member (RM30/year, payable after approval)Associate Member (RM15/year, payable after approval)Life Member (RM300 one-off, payable after approval)

Declaration

I declare that the information given is true, and I agree to abide by the Constitution and rules of the Malaysian Association of Medical Physics (MAMP).

Personal Data Consent

I consent to MAMP collecting and processing my personal data, including my IC number, to administer my membership and maintain the register of members, in accordance with the Personal Data Protection Act 2010.

Scan & Pay via DuitNow

Pay the RM20 registration fee only (non-refundable).
Your annual or Life membership fee is paid after your application is endorsed and approved by the Committee.

Please Make Sure The Receiver Name Is : Persatuan Fizik Perubatan

Or pay online via ToyyibPay (FPX online banking, card or DuitNow)

Pay Membership Fee via ToyyibPay

Pay RM20, then key in the payment reference number below.

Payment Reference Number (RM20 registration fee)

Submit My Application