FFNM membership registration form

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Membership is open to paramedics and doctors only.

Ordinary member subscription is RM 110 (RM 10 for registration + RM100 annual fee)

Life member subscription is RM 1010 (RM 10 for registration + RM 1000).

All membership application is not valid until approval from FFNM Executive committee.

Email address *

Title *

Full name (as per IC)
*

IC number (in 14 digits only) or Passport No *

Date of Birth *

YYYY

Mailing Address *

Postcode *

State *

Contact Number *

Occupation *

Designation *

Name of employer *

Employer Address *

Type of membership *

Ordinary member (RM100 annual subscription + RM 10 registration fee)

Life Member (RM 1000 + RM10 registration fee)

Corporate member (RM 1000 annual subscription + RM 10 registration fee)

Mode of payment *

Cash

Cheque (Payable to "Association Fragility Fracture Network of Malaysia")

Online Transfer (CIMB BANK, Acct no: 800 961 7380)

Please enter your cheque number or online transfer reference number below.

For any queries, please contact us at ffnmalaysia@gmail.com

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